Individual
DR. KERRY L BLOOMINGDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1132 WESTFIELD ST, WEST SPRINGFIELD, MA 01089-3878
(800) 378-5454
Mailing address
PO BOX 260, WESTBOROUGH, MA 01581-0260
(508) 898-8650
(508) 870-9793
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
43793
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15-00675
EVERCARE
MA
01
—
719405
TUFTS MEDICARE PREFERRED
MA
01
—
C04856
BC/BS OF MASSACHUSETTS
MA
05
—
O167959
—
MA
Enumeration date
11/02/2005
Last updated
05/16/2011
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