Provider Demographics
NPI:1447468954
Name:BLOOM, PETER E JR (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:E
Last Name:BLOOM
Suffix:JR
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 1:25 NEWELL RD
Mailing Address - Street 2:SUITE E36
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-5100
Mailing Address - Country:US
Mailing Address - Phone:860-583-9252
Mailing Address - Fax:
Practice Address - Street 1:25 NEWELL RD
Practice Address - Street 2:SUITE E36
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-5100
Practice Address - Country:US
Practice Address - Phone:860-583-9252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT048599207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology