Provider Demographics
NPI:1205994415
Name:BLOM, MARGARET L (MD)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:L
Last Name:BLOM
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:35 EASTWARD LN
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-1744
Mailing Address - Country:US
Mailing Address - Phone:207-667-5999
Mailing Address - Fax:207-667-0555
Practice Address - Street 1:270 HIGH ST
Practice Address - Street 2:SUITE 106
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1729
Practice Address - Country:US
Practice Address - Phone:207-667-5999
Practice Address - Fax:207-667-0555
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2016-08-11
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Provider Licenses
StateLicense IDTaxonomies
ME013869207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM5585OtherMEDICARE
ME130420099Medicaid
MEMM5585OtherMEDICARE
ME130420099Medicaid