Provider Demographics
NPI:1962496810
Name:BLOOMFIELD, ROBERT LEE (MDMS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEE
Last Name:BLOOMFIELD
Suffix:
Gender:M
Credentials:MDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 WESTGATE CENTER DR STE G1
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-2980
Mailing Address - Country:US
Mailing Address - Phone:336-659-6250
Mailing Address - Fax:336-659-6239
Practice Address - Street 1:1365 WESTGATE CENTER DR STE G1
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2980
Practice Address - Country:US
Practice Address - Phone:336-659-6250
Practice Address - Fax:336-659-6239
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23104207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8916312Medicaid
NC8916312Medicaid
NC2163738GMedicare PIN