Blake Gastroenterology Associates, Llc | |
6827-31 Germantown Ave Philadelphia PA 19119-2113 | |
(215) 849-4902 | |
(215) 849-4907 |
Full Name | Blake Gastroenterology Associates, Llc |
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Speciality | Internal Medicine |
Location | 6827-31 Germantown Ave, Philadelphia, Pennsylvania |
Authorized Official Name and Position | James Steven Blake (CEO) |
Authorized Official Contact | 2158494902 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Blake Gastroenterology Associates, Llc 6827-31 Germantown Ave Philadelphia PA 19119-2113 Ph: (215) 849-4902 | Blake Gastroenterology Associates, Llc 6827-31 Germantown Ave Philadelphia PA 19119-2113 Ph: (215) 849-4902 |
NPI Number | 1386729705 |
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Provider Enumeration Date | 10/25/2006 |
Last Update Date | 06/27/2012 |
Medicare PECOS PAC ID | 0648242685 |
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Medicare Enrollment ID | O20040810000714 |
Identifier | Type | State | Issuer |
---|---|---|---|
1386729705 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207RG0100X | Internal Medicine - Gastroenterology | OS007404E (Pennsylvania) | Primary |
Provider Name | James S Blake |
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Provider Type | Practitioner - Gastroenterology |
Provider Identifiers | NPI Number: 1720176381 PECOS PAC ID: 1254350473 Enrollment ID: I20120120000284 |
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