Provider Demographics
NPI:1053349118
Name:MOUGH, RHONDA BLOOM (MD)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:BLOOM
Last Name:MOUGH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RHONDA
Other - Middle Name:
Other - Last Name:BLOOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1202 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7307
Mailing Address - Country:US
Mailing Address - Phone:910-341-3336
Mailing Address - Fax:910-341-3326
Practice Address - Street 1:5211 S COLLEGE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2209
Practice Address - Country:US
Practice Address - Phone:910-341-3300
Practice Address - Fax:910-251-2067
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-01241207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5908328Medicaid
NC147FHOtherBCBS NC
NC5908328Medicaid
NC2074803CMedicare PIN
NC147FHOtherBCBS NC
NC2074803AMedicare PIN
NC2074803BMedicare PIN