Provider Demographics
NPI:1063479467
Name:BLOCH, ROBERT PAUL (DPM)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:PAUL
Last Name:BLOCH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 W CHELTEN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19144
Mailing Address - Country:US
Mailing Address - Phone:215-849-2804
Mailing Address - Fax:215-849-8129
Practice Address - Street 1:515 W CHELTEN AVE
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19144
Practice Address - Country:US
Practice Address - Phone:215-849-2804
Practice Address - Fax:215-849-8129
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001495L213E00000X
NJ25MD00121000213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA05406404Medicaid
PA05406404Medicaid
PABL137793Medicare PIN