MEDICARE: BLOSSOMING MINDS PEDIATRICS

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	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1558173559
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOSSOMING MINDS PEDIATRICS

Provider Business Mailing Address
First Line	:	11540 CHAPEL RISE
Second Line	:
City	:	CLARKSVILLE
State	:	MD
Zip	:	21029-1464
Country	:	US
Telephone Number	:	240-506-0739
Fax Number	:	410-378-8327

Provider Business Practice Location Address
First Line	:	13994 BALTIMORE AVE STE 101
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20707-5174
Country	:	US
Telephone Number	:	410-656-4775
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. KEYVAN RAFEI
Credential	:	MD
Telephone Number	:	240-506-0739

Provider Enumeration Date	:	01/25/2025
Last Update Date	:	01/25/2025

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