Provider Demographics
NPI:1831180363
Name:BLOMSTEDT, JEFFREY W (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:W
Last Name:BLOMSTEDT
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:PO BOX 70266
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1577
Mailing Address - Country:US
Mailing Address - Phone:413-788-6530
Mailing Address - Fax:413-750-8027
Practice Address - Street 1:115 WILDWOOD AVE
Practice Address - Street 2:WESTERN NEW ENGLAND RENAL AND TRANS
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-1215
Practice Address - Country:US
Practice Address - Phone:413-773-5797
Practice Address - Fax:413-773-9009
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA53601207RN0300X
NH9863207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1001541Medicaid
MA6183557Medicaid
NH99904936Medicaid
NHPX6371Medicare PIN
390005233Medicare PIN
A57073Medicare UPIN
MA6183557Medicaid
NH99904936Medicaid