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General NPI Number Information
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NPI Number | 1558173559
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Entity Type | Organization
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Legal Business Name | BLOSSOMING MINDS PEDIATRICS
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Dates
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Enumeration Date | 01/25/2025
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Last Update Date | 01/25/2025
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Provider Practice Location Address
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Address Line | 13994 BALTIMORE AVE STE 101
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City | LAUREL
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State | MD
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Zip | 20707-5174
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Country | US
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Telephone | 410-656-4775
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Fax |
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Provider Business Mailing Address
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Address Line | 11540 CHAPEL RISE
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City | CLARKSVILLE
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State | MD
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Zip | 21029-1464
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Country | US
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Telephone | 240-506-0739
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Fax | 410-378-8327
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. KEYVAN RAFEI
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Credential | MD
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Telephone | 240-506-0739
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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