Provider Demographics
NPI:1528203122
Name:BLANSFIELD, JOSEPH S (NP)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:S
Last Name:BLANSFIELD
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:771 ALBANY ST
Mailing Address - Street 2:DOWLING 2 SOUTH RM 2415
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2525
Mailing Address - Country:US
Mailing Address - Phone:617-414-4088
Mailing Address - Fax:
Practice Address - Street 1:771 ALBANY ST
Practice Address - Street 2:DOWLING 2 SOUTH RM 2415
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2525
Practice Address - Country:US
Practice Address - Phone:617-414-4088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA138982363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner