Individual
MARK T BLOOMSTINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2315 MYRTLE ST STE L10, ERIE, PA 16502-4611
(814) 454-2401
(814) 459-5992
Mailing address
2315 MYRTLE ST STE L10, ERIE, PA 16502-4611
(814) 454-2401
(814) 459-5992
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
MD044032L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000665455
HIGHMARK
PA
05
—
0012416530002
—
PA
01
—
200019047
RAILROAD MEDICARE
—
Enumeration date
04/19/2006
Last updated
09/30/2020
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