Individual
MARK R BLADERGROEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5875 BREMO RD, SUITE G-5, RICHMOND, VA 23226-1934
(804) 287-7840
(804) 287-7845
Mailing address
5875 BREMO RD, SUITE G-5, RICHMOND, VA 23226-1934
(804) 287-7840
(804) 287-7845
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
0101042193
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0101042193
MEDICAL LICENSE
VA
05
—
7300221
—
VA
01
—
C06778
GROUP PTAN
VA
Enumeration date
07/04/2006
Last updated
03/07/2023
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