Provider Demographics
NPI:1568002418
Name:DOUBLE BLAZE HEALTH, INC.
Entity Type:Organization
Organization Name:DOUBLE BLAZE HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARYBETH
Authorized Official - Middle Name:T
Authorized Official - Last Name:STOCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:240-644-4146
Mailing Address - Street 1:PO BOX 1012
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20875-1012
Mailing Address - Country:US
Mailing Address - Phone:301-500-9402
Mailing Address - Fax:
Practice Address - Street 1:18928 LIBERTY MILL RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-1414
Practice Address - Country:US
Practice Address - Phone:301-500-9402
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty