1306919865 NPI number — CAROL BLEAM D.C.

Table of content: CAROL BLEAM D.C. (NPI 1306919865)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306919865 NPI number — CAROL BLEAM D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLEAM
Provider First Name:
CAROL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

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:
1306919865
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/23/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1643 LIBERTY RD STE 206
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELDERSBURG
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21784-6543
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-795-0400
Provider Business Mailing Address Fax Number:
443-687-8735

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1643 LIBERTY RD STE 206
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELDERSBURG
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21784-6543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-795-0400
Provider Business Practice Location Address Fax Number:
443-687-8735
Provider Enumeration Date:
11/15/2006

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: 111NR0400X , with the licence number:  SO3386 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2136292 . This is a "ALLIANCE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2140007 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2136292 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 52185508 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 3798356 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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