Provider Demographics
NPI:1093168809
Name:BLOOM OB GYN, LLC
Entity Type:Organization
Organization Name:BLOOM OB GYN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:OSMUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-449-9570
Mailing Address - Street 1:4001 BRANDYWINE ST NW
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-1876
Mailing Address - Country:US
Mailing Address - Phone:202-449-9570
Mailing Address - Fax:202-449-9513
Practice Address - Street 1:4001 BRANDYWINE ST NW STE 300
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-1876
Practice Address - Country:US
Practice Address - Phone:202-449-9570
Practice Address - Fax:202-449-9513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-16
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty