Provider Demographics
NPI:1437361557
Name:BLOSSOM OBSTETRICS, GYNECOLOGY & INFERTILITY, P.A.
Entity Type:Organization
Organization Name:BLOSSOM OBSTETRICS, GYNECOLOGY & INFERTILITY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHORNESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-662-5000
Mailing Address - Street 1:420 THE PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-5206
Mailing Address - Country:US
Mailing Address - Phone:864-662-5000
Mailing Address - Fax:864-662-5008
Practice Address - Street 1:420 THE PKWY STE C
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-5206
Practice Address - Country:US
Practice Address - Phone:864-662-5000
Practice Address - Fax:864-662-5008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17267207VH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VH0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3495Medicaid
SC7339Medicare ID - Type Unspecified
SCGP3495Medicaid