Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | MT186824 | PA |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 256050 | NY |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | MD432401 | PA |
NPI | 1184780108 |
---|---|
Provider Name | Dr. Jason David Bloom |
First Address | Bryn Mawr, PA 19010-3420 |
Second Address | Bryn Mawr, PA 19010-3420 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2006 |
Last Update Date | 09/12/2021 |