Basic Information
| Provider Information | |||||||||
| NPI: | 1053380964 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLUMBERG | ||||||||
| FirstName: | KIM | ||||||||
| MiddleName: | RITA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 PROVIDENCE RD | ||||||||
| Address2: | STE. 101 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282071468 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047495800 | ||||||||
| FaxNumber: | 7047495819 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 HAWTHORNE LN | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282042515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047495800 | ||||||||
| FaxNumber: | 7047495819 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 03/22/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 01058708A | IN | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 2010-01959 | NC | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.