Provider Demographics
NPI:1043391816
Name:BLAIR RENAL ASSOCIATES INC
Entity Type:Organization
Organization Name:BLAIR RENAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:MANON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-944-2107
Mailing Address - Street 1:501 HOWARD AVE
Mailing Address - Street 2:SUITE D204
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-4810
Mailing Address - Country:US
Mailing Address - Phone:814-944-2107
Mailing Address - Fax:814-944-6208
Practice Address - Street 1:501 HOWARD AVE
Practice Address - Street 2:SUITE D204
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4810
Practice Address - Country:US
Practice Address - Phone:814-944-2107
Practice Address - Fax:814-944-6208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty