Individual
MS. ILENE S BLOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
116 DEFENSE HWY, SUITE 400, ANNAPOLIS, MD 21401-7027
(410) 897-9841
(410) 897-9852
Mailing address
116 DEFENSE HWY, SUITE 400, ANNAPOLIS, MD 21401-7027
(410) 897-9841
(410) 897-9852
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
C01316
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C001316
STATE LICENSE
MD
Enumeration date
11/28/2006
Last updated
08/13/2014
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