Provider Demographics
NPI:1760697635
Name:BLOOM, KATHERINE ALEXIS (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:ALEXIS
Last Name:BLOOM
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:55 WALLS DR
Mailing Address - Street 2:SUITE 405
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5163
Mailing Address - Country:US
Mailing Address - Phone:203-259-7070
Mailing Address - Fax:203-254-7402
Practice Address - Street 1:55 WALLS DR
Practice Address - Street 2:SUITE 405
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5163
Practice Address - Country:US
Practice Address - Phone:203-259-7070
Practice Address - Fax:203-254-7402
Is Sole Proprietor?:No
Enumeration Date:2007-05-13
Last Update Date:2015-12-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT047707207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology