Organization
BLOOMING MEDICAL GROUP, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EMILY BECKER PEVTSOV PA (OWNER)
(910) 644-0887
Entity
Organization
Contact information
Practice address
964 HIGH HOUSE RD UNIT 4037, CARY, NC 27513-3574
(910) 644-0887
Mailing address
964 HIGH HOUSE RD UNIT 4037, CARY, NC 27513-3574
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00414600
—
NC
Enumeration date
12/21/2021
Last updated
01/31/2023
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