Provider Demographics
NPI:1679758122
Name:BLOOMFIELD, RICHARD ALAN (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALAN
Last Name:BLOOMFIELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 969
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28570-0969
Mailing Address - Country:US
Mailing Address - Phone:252-223-5054
Mailing Address - Fax:252-223-4038
Practice Address - Street 1:338 HOWARD BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NC
Practice Address - Zip Code:28570-7928
Practice Address - Country:US
Practice Address - Phone:252-223-5054
Practice Address - Fax:252-223-4038
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-03
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22460207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC080051402OtherRAILROAD MEDICARE
NC343858AMedicaid
NC561384536OtherTRICARE CHAMPUS
NC8916314Medicaid
NCC82849Medicare UPIN
NC561384536OtherTRICARE CHAMPUS
NC343858Medicare Oscar/Certification