David H Blom, DO
Individual provider Active NPI Specialist · Vineland, NJ
NPI 1790776789 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1790776789
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- Practice address
- 1027 E Chestnut Ave
Vineland, NJ 08360-5838 - Phone
- (856) 696-9550
- Fax
- (856) 691-1686
- NPI assigned
- Oct 31, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230901003140 | NJ | Order and Referring Only - Medical Oncology |
6608889662 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southern Oncology Hematology Assoc | Specialist | Current | Accepting new patients |
Locations
1505 W Sherman Ave
#101
Vineland, NJ 08360
Phone (856) 696-9550
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | Yes |
Addresses
Primary practice location
1027 E Chestnut Ave
Vineland, NJ 08360-5838
Mailing address
1027 E Chestnut Ave
Vineland, NJ 08360-5838
Other providers in Vineland, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.