Individual
PAUL HENRY BLOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3448 US ROUTE 60, HUNTINGTON, WV 25705-2906
(304) 522-1550
(304) 522-0704
Mailing address
PO BOX 910, RADIOLOGY INC, HUNTINGTON, WV 25712-0910
(304) 522-1550
(304) 522-1073
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
35-085169
OH
2085R0202X
Diagnostic Radiology Physician
39150
KY
2085R0204X
Vascular & Interventional Radiology Physician
Primary
21514
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000205297
UNISON
OH
01
—
000011745
MTN STATE BCBS
—
05
—
1810941000
—
WV
05
—
2466031
—
OH
01
—
50007259
PASSPORT
KY
01
—
55079337600
WORKMANS COMP
WV
05
—
6407884300
—
KY
01
—
7061267
AETNA
—
01
—
P00099468
RR MEDICARE (WV)
WV
Enumeration date
12/22/2005
Last updated
05/07/2024
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