Basic Information
| Provider Information | |||||||||
| NPI: | 1093168809 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BLOOM OB GYN, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4001 BRANDYWINE ST NW | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200161876 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2024499570 | ||||||||
| FaxNumber: | 2024499513 | ||||||||
| Practice Location | |||||||||
| Address1: | 4001 BRANDYWINE ST NW STE 300 | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200161876 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2024499570 | ||||||||
| FaxNumber: | 2024499513 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2016 | ||||||||
| LastUpdateDate: | 03/26/2019 | ||||||||
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| AuthorizedOfficialLastName: | OSMUN | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 2024499570 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.