MARK A BLUMBERG (NPI# 1588662019) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588662019 |
| Entity Type | Individual |
| Full Name | MARK A BLUMBERG |
| Credential | M.D. |
| Practice Address |
3455 Main St Suite 5 Springfield MA 01107-1147 |
| Practice Telephone | 4137339600 |
| Practice Fax Number | 4137326534 |
| Mailing Telephone | 4137339600 |
| Mailing Fax Number | 4137326534 |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2007-11-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | 223863 | MA | Allopathic & Osteopathic Physicians |
| N | 207ND0900X |
Dermatology Specialization: Dermatopathology |
223863 | MA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CONNECTICARE | 223863 | 01 | |
| MA | BLUE CROSS BLUE SHIELD | J28609 | 01 |
| HEALTH NEW ENGLAND | 36373 | 01 | |
| TUFTS HEALTH PLANS | 470305 | 01 | |
| RAILROAD MEDICARE | P00231584 | 01 |
| Street Address |
3455 MAIN ST SUITE 5 |
| City | SPRINGFIELD |
| State | MA |
| Zip Code | 01107-1147 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447255013 | Orthotics West, Inc | Prosthetic/Orthotic Supplier | 3455 Main St, Springfield, MA 01107-1147 | 2005-06-20 |
| 1134643281 | Jennifer Vo | Physician Assistant | 3455 Main St, Springfield, MA 01107-1187 | 2017-07-31 |
| 1336682509 | Kelly Ann Ostrowski | Advanced Practice Midwife | 3455 Main St, Springfield, MA 01107-1187 | 2016-11-21 |
| 1902268519 | March Eagers Thompson | Obstetrics & Gynecology | 3455 Main St, Springfield, MA 01107-1187 | 2016-03-23 |
| 1366881203 | Fariha Mahmood Quereshy | Nurse Practitioner | 3455 Main St, Suite 5, Springfield, MA 01107-1142 | 2013-06-24 |
| 1992988869 | Gary H Goodman | Dentist | 3455 Main St, Springfield, MA 01107-1147 | 2007-12-13 |
| 1083897953 | Aaron M Fox | Dentist | 3455 Main St, Springfield, MA 01107-1147 | 2007-12-13 |
| 1679756548 | Richard A Goodman | Dentist | 3455 Main St, Suite 102, Springfield, MA 01107-1147 | 2007-12-13 |
| 1982885950 | Paul F. Walker Md,pc | Allergy & Immunology | 3455 Main St, Suite 7, Springfield, MA 01107-1147 | 2007-11-19 |
| 1578788659 | David Wartman | Dermatology | 3455 Main St, Ste. # 5, Springfield, MA 01107-1142 | 2007-04-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740702547 | Domingo Nieves Jr. | Counselor | 2225 Main St., Springfield, MA 01107 | 2017-07-13 |
| 1801318266 | Denise Lawson | Counselor | 2257 Main Street, Springfield, MA 01107 | 2017-07-07 |
| 1568912491 | Trina Cysz | Nurse Practitioner | 101 Wason Avenue, Commonwealth Care Alliance, Springfield, MA 01107 | 2016-10-04 |
| 1609322262 | Toheeb Oladimeji Bakare | Counselor | 322 Birnie Avenue, Springfield, MA 01107 | 2016-09-01 |
| 1952701161 | Jalissa Sostre | Counselor | 32 Abbe Ave, Springfield, MA 01107 | 2014-08-26 |
| 1659799161 | Elizabeth A. Otmaskin | Obstetrics & Gynecology | 3455 Main Street Suite C, Baysttate Ob Gyn Group Inc, Springfield, MA 01107 | 2014-04-01 |
| 1205268885 | Catherine Matejcek Davies | Counselor | 246 Park Street, Springfield, MA 01107 | 2013-08-06 |
| 1750723268 | Jasdeep S. Badwal | Allergy & Immunology | 2 Medical Center Dr Ste 406, Springfield, MA 01107 | 2013-07-25 |
| 1255691846 | Medical Express Urgent Care Center, Co. Inc. | Physical Medicine & Rehabilitation | 438 Chestnut Street, Springfield, MA 01107 | 2012-05-17 |
| 1205166642 | Matthew R Kelley | Audiologist | 100 Wason, Suite 100, Springfield, MA 01107 | 2010-01-07 |
| Find all providers in zip 01107 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669090445 | Peter T Demos Md | Dermatology | 125 Liberty St Ste 206, Springfield, MA 01103-1109 | 2020-07-08 |
| 1952674798 | Ernest Lorenc | Dermatology | 2053 S Pin Oak Drive, Springfield, MO 65809-3142 | 2012-02-09 |
| 1437302452 | Dermatology Clinic of Springfield | Dermatology | 1605 G Street, Springfield, OR 97477-4227 | 2008-11-04 |
| 1750585741 | Nicole Marie Cassler | Dermatology | Oregon Medical Group Dermatology, 1007 Harlow Rd., Springfield, OR 97477-7124 | 2007-06-13 |
| 1942386677 | Larry Michael Newell | Dermatology | 2951 Montvale Dr, Suite B, Springfield, IL 62704-5341 | 2006-10-27 |
| 1063517746 | Adarsh A Kumar | Dermatology | 2040 Timberbrooke Drive, Springfield, IL 62702 | 2006-09-14 |
| 1558385989 | Siu Physicians & Surgeons, Inc | Dermatology | 201 E Madison St Ste 300, Springfield, IL 62702-5131 | 2006-07-27 |
| 1114961067 | Catherine L Laughlin | Dermatology | 1536 E Primrose St, Springfield, MO 65804-7928 | 2006-06-15 |
| 1891763868 | W Gerald Klingler | Dermatology | 355 W Carpenter Street Ste A, Springfield, IL 62702 | 2006-03-08 |
| 1801866231 | Jenifer Dawn Insley | Dermatology | 3808 S Greystone Ct, Springfield, MO 65804-6561 | 2006-01-26 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 01107 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.