Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Ellis Jeremy Bloom, DO

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1124875059

Dr. Ellis Jeremy Bloom, DO is a Student in an Organized Health Care Education/Training Program in Providence, Rhode Island. Licensed in Rhode Island. Registered with an NPI since 2024.

Licensed in
RI
In the registry since
2024
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

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Practice location Address checks out

593 Eddy St
Providence, RI 02903-4923
Phone: (401) 793-2695
Fax: (401) 444-4165
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X · Licence LP06198 (RI)

Record details

NPI number1124875059
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorNo
NPI enumeratedApril 30, 2024
Last updated in NPPESApril 30, 2024
Certification dateApril 30, 2024

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