Provider Demographics
NPI:1558337824
Name:BLAIR, IRENE F (NP)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:F
Last Name:BLAIR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 NEPONSET ST FL 12
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2714
Mailing Address - Country:US
Mailing Address - Phone:508-595-2655
Mailing Address - Fax:508-854-0822
Practice Address - Street 1:5 NEPONSET ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-2714
Practice Address - Country:US
Practice Address - Phone:508-595-2655
Practice Address - Fax:508-854-0822
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA144383363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
042472266002OtherTRICARE
NP3378OtherBLUE SHIELD INDEMNITY
NP3378OtherMEDICARE B
57181OtherFALLON COMM HEALTH PLAN
NP3378OtherBLUE SHIELD HMO BLUE
042472266OtherTHREE RIVERS
042472266002OtherCHAMPUS
AA459OtherHARVARD PILGRIM HLTHCARE
NP3378OtherBLUE CARE ELECT
042472266OtherPRIVATE HEALTHCARE SYST
381321OtherMVP HEALTH CARE
8301269OtherEVERCARE
381321OtherMVP HEALTH CARE
P36506Medicare UPIN