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General NPI Number Information
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NPI Number | 1508286626
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Entity Type | Individual
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Provider Name | BLOSSOM MARIMPIETRI HEINDEL DO
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Gender | Female
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Dates
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Enumeration Date | 04/16/2014
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Last Update Date | 10/26/2018
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Provider Practice Location Address
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Address Line | 3838 MASSILLON RD
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City | UNIONTOWN
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State | OH
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Zip | 44685-7964
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Country | US
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Telephone | 330-835-5533
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Fax |
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Provider Business Mailing Address
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Address Line | 3838 MASSILLON RD
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City | UNIONTOWN
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State | OH
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Zip | 44685-7964
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Country | US
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Telephone | 330-835-5533
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 34.012411
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 34.012411
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License Number State | OH
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