Provider Demographics
NPI:1720034838
Name:BLOOM, EDWARD W (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:W
Last Name:BLOOM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:709 W ORCHARD DR
Mailing Address - Street 2:SUITE #4
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1766
Mailing Address - Country:US
Mailing Address - Phone:360-318-8800
Mailing Address - Fax:360-318-1085
Practice Address - Street 1:3500 ORCHARD PL
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1749
Practice Address - Country:US
Practice Address - Phone:360-671-3900
Practice Address - Fax:360-647-0882
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2012-08-27
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Provider Licenses
StateLicense IDTaxonomies
WAMD00044691207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8904494OtherLABOR & INDUSTRIES (CV)
WAP00239431OtherRAILROAD MEDICARE
WA423898073OtherGROUP HEALTH COOPERATIVE
WA0194091OtherLABOR & INDUSTRIES (REG)
WA5748BLOtherREGENCE BLUESHIELD
WA0194091OtherLABOR & INDUSTRIES (REG)
WA8904494OtherLABOR & INDUSTRIES (CV)
WAG8852555Medicare PIN