Bloom, Ilene S
Bloom, Ilene S is an individual health care provider with primary practice located at 116 Defense Hwy Suite 400, Annapolis MD 21401-7027. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as her primary health care specialty. Bloom, Ilene S can be contacted via phone (410) 897-9841.Contact Information
Primary practice address
116 Defense Hwy Suite 400
Annapolis MD 21401-7027
Phone: (410) 897-9841
Fax: (410) 897-9852
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | C01316 | Maryland |
Profile Details
| NPI number | 1790851996 |
|---|---|
| LBN Legal business name | Bloom, Ilene S |
| Credentials | PAC |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 28th, 2006 |
| Last updated | Aug 13th, 2014 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1790851996 | NPPES |
| Maryland | Other | C001316 | STATE LICENSE |
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