Provider Demographics
NPI:1710042932
Name:BLOEM, FREDERIK HENDRIK (MD)
Entity type:Individual
Prefix:DR
First Name:FREDERIK
Middle Name:HENDRIK
Last Name:BLOEM
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 1:4108 ALFALFA TER
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-2962
Mailing Address - Country:US
Mailing Address - Phone:301-260-2601
Mailing Address - Fax:800-595-4160
Practice Address - Street 1:4108 ALFALFA TER
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-2962
Practice Address - Country:US
Practice Address - Phone:301-260-2601
Practice Address - Fax:800-595-4160
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0046760207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine