Provider Demographics
NPI:1053380964
Name:BLUMBERG, KIM RITA (MD)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:RITA
Last Name:BLUMBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:200 PROVIDENCE RD
Mailing Address - Street 2:STE. 101
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1468
Mailing Address - Country:US
Mailing Address - Phone:704-749-5800
Mailing Address - Fax:704-749-5819
Practice Address - Street 1:200 HAWTHORNE LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2515
Practice Address - Country:US
Practice Address - Phone:704-749-5800
Practice Address - Fax:704-749-5819
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01058708A207L00000X
NC2010-01959207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC0003AMedicare PIN