Provider Demographics
NPI:1992781413
Name:ROSENBLOOM, ALAN ABRAHAM (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:ABRAHAM
Last Name:ROSENBLOOM
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 1:1910 N CHURCH ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405
Mailing Address - Country:US
Mailing Address - Phone:336-574-0707
Mailing Address - Fax:336-574-0039
Practice Address - Street 1:1910 N CHURCH ST
Practice Address - Street 2:SUITE 4
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405
Practice Address - Country:US
Practice Address - Phone:336-574-0707
Practice Address - Fax:336-574-0039
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800373207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891193AMedicaid
NC891193AMedicaid