Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 0000835 | MA |
NPI | 1184604555 |
---|---|
Provider Name | Dr. Paul Richard Blomerth |
First Address | Ludlow, MA 01056-3469 |
Second Address | Ludlow, MA 01056-3469 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2006 |
Last Update Date | 12/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1611968 | (05) | MA |
T58266 | (02) | MA |