MEDICARE: BLOSSOM BEGINNINGS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374J00000X	Doula

General Provider Information

NPI Number	:	1205401130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOSSOM BEGINNINGS LLC

Provider Business Mailing Address
First Line	:	9466 GEORGIA AVE STE 559
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-1456
Country	:	US
Telephone Number	:	202-813-0995
Fax Number	:

Provider Business Practice Location Address
First Line	:	9466 GEORGIA AVE STE 559
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-1456
Country	:	US
Telephone Number	:	202-813-0995
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TARRYN BAZEMORE
Credential	:
Telephone Number	:	443-875-9132

Provider Enumeration Date	:	05/24/2021
Last Update Date	:	05/24/2021

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Directions to “BLOSSOM BEGINNINGS LLC ” Practice Location

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