Provider Demographics
NPI:1053304725
Name:BLAHEY, MARIA SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:SUSAN
Last Name:BLAHEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 N 11TH ST
Mailing Address - Street 2:SUITE P-5200
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1501
Mailing Address - Country:US
Mailing Address - Phone:409-898-2994
Mailing Address - Fax:409-899-5542
Practice Address - Street 1:755 N 11TH ST
Practice Address - Street 2:SUITE P-5200
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1501
Practice Address - Country:US
Practice Address - Phone:409-898-2994
Practice Address - Fax:409-899-5542
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1816207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXY0048390OtherSTATE DPS LICENSE
TXG1816OtherSTATE LICENSE
TX156968301Medicaid
TXTAX IDOther741903407
TXTAX IDOther741903407
TXAB1618290OtherFEDERAL DEA
TX00992TMedicare ID - Type UnspecifiedPROVIDER NUMBER