Provider Demographics
NPI:1487820502
Name:BLAIR, MICHAEL ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ARTHUR
Last Name:BLAIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:402 LIPPINCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4112
Mailing Address - Country:US
Mailing Address - Phone:856-782-3300
Mailing Address - Fax:856-504-8029
Practice Address - Street 1:119 WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1909
Practice Address - Country:US
Practice Address - Phone:856-547-7300
Practice Address - Fax:856-547-4573
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2010-03-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA08543300208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
077356 SK3Medicare PIN