Provider Demographics
NPI:1700834041
Name:BLOOMGARDEN, RAPHAEL T (MD)
Entity type:Individual
Prefix:DR
First Name:RAPHAEL
Middle Name:T
Last Name:BLOOMGARDEN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3500 N BROAD ST RM 1A
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-4106
Mailing Address - Country:US
Mailing Address - Phone:215-926-9019
Mailing Address - Fax:215-233-9710
Practice Address - Street 1:1722 BETHLEHEM PIKE
Practice Address - Street 2:CHESTNUT HILL CARDIOLOGY LTD
Practice Address - City:FLOURTOWN
Practice Address - State:PA
Practice Address - Zip Code:19031-1644
Practice Address - Country:US
Practice Address - Phone:215-233-9700
Practice Address - Fax:215-233-9710
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2024-07-03
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Provider Licenses
StateLicense IDTaxonomies
PAMD027044E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA597586OtherMEDICARE TPI GROUP
PA1007278000OtherMEDICAID TPI GROUP
PACD4829OtherRAILROAD MEDICARE TPI