1043215833 NPI number — CARL F. ROSENBLOOM M.D.

Table of content: CARL F. ROSENBLOOM M.D. (NPI 1043215833)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043215833 NPI number — CARL F. ROSENBLOOM M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSENBLOOM
Provider First Name:
CARL
Provider Middle Name:
F.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043215833
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 PARKWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAVERHILL
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01830-6278
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-521-3230
Provider Business Mailing Address Fax Number:
978-374-5412

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 PARKWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAVERHILL
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01830-6278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-521-3230
Provider Business Practice Location Address Fax Number:
978-521-3256
Provider Enumeration Date:
06/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  32048 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2080A0000X , with the licence number: 32048 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1043215833 . This is a "FALLON COMMUNITY HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 110034897A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200224 . This is a "HARVARD PILGRIM HEALTHCAR" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: D22815 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 1043215833 . This is a "AETNA HMO" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 99903687 . This is a "NEW HAMPSHIRE MEDICAID" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 0016287 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6666914 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4052726 . This is a "AETNA NON HMO" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 979676 . This is a "NETWORK HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: D11098 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 678819 . This is a "HEALTHSOURCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 706897 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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