Provider Demographics
NPI:1275270233
Name:REID, BLAKE ANDREW
Entity Type:Individual
Prefix:
First Name:BLAKE
Middle Name:ANDREW
Last Name:REID
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1954 UPPER CHELSEA RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-4113
Mailing Address - Country:US
Mailing Address - Phone:614-736-7671
Mailing Address - Fax:
Practice Address - Street 1:1954 UPPER CHELSEA RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-4113
Practice Address - Country:US
Practice Address - Phone:614-736-7671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant