Provider Demographics
NPI:1255501557
Name:BLOSSOM, DAVID B (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:B
Last Name:BLOSSOM
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3609 PARK EAST DR
Mailing Address - Street 2:#207
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4331
Mailing Address - Country:US
Mailing Address - Phone:216-360-0456
Mailing Address - Fax:216-360-9449
Practice Address - Street 1:6115 POWERS BLVD
Practice Address - Street 2:#205
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5471
Practice Address - Country:US
Practice Address - Phone:440-884-2909
Practice Address - Fax:440-884-3766
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2008-08-07
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Provider Licenses
StateLicense IDTaxonomies
OH35086446207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2837943Medicaid