Basic Information
| Provider Information | |||||||||
| NPI: | 1376554113 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STEVEN B. BLUMBERG, DO, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 68 CAMP ST | ||||||||
| Address2: | |||||||||
| City: | HYANNIS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 026013048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087754100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 68 CAMP ST | ||||||||
| Address2: | |||||||||
| City: | HYANNIS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 026013048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087754100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2006 | ||||||||
| LastUpdateDate: | 07/28/2008 | ||||||||
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| AuthorizedOfficialLastName: | BLUMBERG | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5087754100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 9700510 | 05 | MA | MEDICAID |