Provider Demographics
NPI:1912904624
Name:BLEIER, JOEL G (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:G
Last Name:BLEIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CITY HALL MALL
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4770
Mailing Address - Country:US
Mailing Address - Phone:781-395-2922
Mailing Address - Fax:781-393-8905
Practice Address - Street 1:1 CITY HALL MALL
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-4770
Practice Address - Country:US
Practice Address - Phone:781-395-2922
Practice Address - Fax:781-393-8905
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA42472207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA042472OtherTUFTS HMO
MA042763605OtherMISC. HMO
MA042763605OtherMISC. HMO
A67796Medicare UPIN