Provider Demographics
NPI:1841797446
Name:BLOOMQUIST, MARIA SUZANNE BOSLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:SUZANNE BOSLEY
Last Name:BLOOMQUIST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8825 BEE CAVES RD STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-4721
Mailing Address - Country:US
Mailing Address - Phone:512-328-3376
Mailing Address - Fax:512-666-3767
Practice Address - Street 1:8825 BEE CAVES RD STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-4721
Practice Address - Country:US
Practice Address - Phone:512-328-3376
Practice Address - Fax:512-666-3767
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU0966207ZP0102X, 207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology