Provider Demographics
NPI:1336282698
Name:BLAIR MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:BLAIR MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROJECTS MGR.
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-949-7621
Mailing Address - Street 1:1414 9TH AVE
Mailing Address - Street 2:STATION MEDICAL CENTER
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-2415
Mailing Address - Country:US
Mailing Address - Phone:814-946-1655
Mailing Address - Fax:814-949-7616
Practice Address - Street 1:149 DEVILLE DRIVE
Practice Address - Street 2:
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635
Practice Address - Country:US
Practice Address - Phone:814-693-0628
Practice Address - Fax:814-693-0637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1530694OtherGATEWAY PEDS NUMBER
PA1007393100024Medicaid
PA1508647OtherGATEWAY FP NUMBER
PAW442OtherGEISINGER OFFICE NO
PA1007393100025Medicaid