Provider Demographics
NPI:1124016886
Name:BLORE, JAMES P JR (M D)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:BLORE
Suffix:JR
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5612 EASTON RD
Mailing Address - Street 2:
Mailing Address - City:PLUMSTEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18949
Mailing Address - Country:US
Mailing Address - Phone:215-766-8844
Mailing Address - Fax:
Practice Address - Street 1:5612 EASTON RD
Practice Address - Street 2:
Practice Address - City:PLUMSTEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:18949
Practice Address - Country:US
Practice Address - Phone:215-766-8844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019193E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0654953Medicaid
B35258Medicare UPIN
PA0654953Medicaid