Provider Demographics
NPI:1770743064
Name:BLOCH, MICHAEL HOWARD (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:HOWARD
Last Name:BLOCH
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 1:3 WOODBINE ST
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517-2026
Mailing Address - Country:US
Mailing Address - Phone:203-785-7683
Mailing Address - Fax:203-785-7611
Practice Address - Street 1:3 WOODBINE ST
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06517-2026
Practice Address - Country:US
Practice Address - Phone:203-785-7683
Practice Address - Fax:203-785-7611
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0457372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry