Healthcare Provider Details

I. General information

NPI: 1659837797
Provider Name (Legal Business Name): BLUSH BEAUTY BAR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 09/05/2022
Certification Date: 09/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 EUTAW PL STE 2
BALTIMORE MD
21217-3605
US

IV. Provider business mailing address

1369 WALKER AVE
BALTIMORE MD
21239-1704
US

V. Phone/Fax

Practice location:
  • Phone: 410-446-2791
  • Fax: 667-218-3785
Mailing address:
  • Phone: 410-446-2791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name: MS. MELISSA MARIA ROBINSON
Title or Position: PROTHESIS SPECIALIST/ OWNER
Credential: CERTIFIED HAIRLOSS
Phone: 410-446-2791