Provider Demographics
NPI:1861468233
Name:BLOOR, NICOLE ANNE (MD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANNE
Last Name:BLOOR
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:PO BOX 3237
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01888-3237
Mailing Address - Country:US
Mailing Address - Phone:781-338-7170
Mailing Address - Fax:781-338-7173
Practice Address - Street 1:888 MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-4080
Practice Address - Country:US
Practice Address - Phone:781-620-4888
Practice Address - Fax:781-245-2602
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA80960207R00000X, 207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0401949OtherUH
MA66934OtherHP
MA9700480Medicaid
MA989581OtherNETWORK HEALTH
MAJ31895OtherBC
MAB10318801OtherCIGNA
MA080960OtherTUFTS
MAM17510OtherBC - GROUP #
MA3140016Medicaid
G05234Medicare UPIN
MAM20832Medicare ID - Type UnspecifiedGROUP #
MAJ31895OtherBC