Provider Demographics
NPI:1922379296
Name:BLUMBERG, VICKI SARA (MD)
Entity Type:Individual
Prefix:DR
First Name:VICKI
Middle Name:SARA
Last Name:BLUMBERG
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 1:203 OSCALETA RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-3612
Mailing Address - Country:US
Mailing Address - Phone:203-856-8360
Mailing Address - Fax:
Practice Address - Street 1:203 OSCALETA RD
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-3612
Practice Address - Country:US
Practice Address - Phone:203-856-8360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028371207R00000X
CAG5052207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine