Provider Demographics
NPI:1215227467
Name:BLOHM, EIKE (MD)
Entity type:Individual
Prefix:
First Name:EIKE
Middle Name:
Last Name:BLOHM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 COLCHESTER AVENUE
Mailing Address - Street 2:UVM MEDICAL CENTER, EMERGENCY DEPARTMENT
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401
Mailing Address - Country:US
Mailing Address - Phone:802-847-2434
Mailing Address - Fax:802-847-4802
Practice Address - Street 1:111 COLCHESTER AVENUE
Practice Address - Street 2:UVM MEDICAL CENTER, EMERGENCY DEPARTMENT
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401
Practice Address - Country:US
Practice Address - Phone:802-847-2434
Practice Address - Fax:802-847-4802
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA261731207P00000X
VT042.0013721207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110102259AMedicaid
MAS400229000Medicare PIN