Provider Demographics
NPI:1184780108
Name:BLOOM, JASON DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:DAVID
Last Name:BLOOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2 TOWN PL STE 110
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3420
Mailing Address - Country:US
Mailing Address - Phone:610-762-5666
Mailing Address - Fax:484-380-3550
Practice Address - Street 1:2 TOWN PL STE 110
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3420
Practice Address - Country:US
Practice Address - Phone:610-762-5666
Practice Address - Fax:484-380-3550
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT186824207Y00000X
NY256050207YX0905X
PAMD432401207YX0905X
NJ25MA08884600207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology