Provider Demographics
NPI:1093784142
Name:JOY, BLOSSOM (DO)
Entity Type:Individual
Prefix:DR
First Name:BLOSSOM
Middle Name:
Last Name:JOY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9963 BUSTLETON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-1557
Mailing Address - Country:US
Mailing Address - Phone:484-885-7503
Mailing Address - Fax:
Practice Address - Street 1:9963 BUSTLETON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-1557
Practice Address - Country:US
Practice Address - Phone:484-885-7503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009215L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268054800Medicaid
FL81600OtherBCBS
FL268054800Medicaid
FL81600OtherBCBS