Individual
BLAKE BLOOMFIELD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1000 BLYTHE BLVD, CHARLOTTE, NC 28203-5812
(704) 446-5185
Mailing address
145 NEW BERN ST APT 143, CHARLOTTE, NC 28209-4301
(810) 962-3192
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
04/30/2021
Last updated
06/13/2025
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