| Blossom Integrated Health And Behavioral Services Llc | |
|
338 Mill St Hagerstown MD 21740-6138 | |
| (240) 347-4494 | |
| (240) 347-4495 |
| Full Name | Blossom Integrated Health And Behavioral Services Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 338 Mill St, Hagerstown, Maryland |
| Authorized Official Name and Position | Ihuoma Marvelous Udeagha (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 2404904242 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blossom Integrated Health And Behavioral Services Llc 338 Mill St Hagerstown MD 21740-6138 Ph: (340) 347-4494 | Blossom Integrated Health And Behavioral Services Llc 338 Mill St Hagerstown MD 21740-6138 Ph: (240) 347-4494 |
| NPI Number | 1851081095 |
|---|---|
| Provider Enumeration Date | 05/10/2023 |
| Last Update Date | 04/26/2024 |
| Certification Date | 04/26/2024 |
| Medicare PECOS PAC ID | 7113380452 |
|---|---|
| Medicare Enrollment ID | O20230905000018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851081095 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| Provider Name | Ihuoma Udeagha |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649828633 PECOS PAC ID: 6507198397 Enrollment ID: I20191028003115 |
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