Provider Demographics
NPI:1457498990
Name:BLOSE, LINDA K (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:K
Last Name:BLOSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:801 OSTRUM ST
Mailing Address - Street 2:ENROLLMENT CENTER
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1000
Mailing Address - Country:US
Mailing Address - Phone:484-526-6048
Mailing Address - Fax:484-526-6500
Practice Address - Street 1:2445 PLAZA CT
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:PA
Practice Address - Zip Code:18014-8762
Practice Address - Country:US
Practice Address - Phone:610-837-8710
Practice Address - Fax:610-837-7820
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2014-11-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD031537E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA126344Medicare ID - Type Unspecified
PAC30957Medicare UPIN