Provider Demographics
NPI:1578510160
Name:ARDMAN, BLAIR (MD)
Entity Type:Individual
Prefix:
First Name:BLAIR
Middle Name:
Last Name:ARDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 VARNUM AVE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-2134
Mailing Address - Country:US
Mailing Address - Phone:978-937-6258
Mailing Address - Fax:978-788-7968
Practice Address - Street 1:295 VARNUM AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-2134
Practice Address - Country:US
Practice Address - Phone:978-937-6258
Practice Address - Fax:978-788-7968
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA47026207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0027504OtherNEIGHBORHOOD HEALTH
MA6175503Medicaid
97860302OtherNETWORK HEALTH
3000272OtherEVERCARE
9478OtherHARVARD PILGRIM
MAJ02988OtherBLUE CROSS BLUE SHIELD
41294OtherFALLON COMMUNITY HEALTH
B20061902OtherCIGNA
4034356OtherAETNA
701815OtherTUFTS HEALTH PLAN
MAJ02988OtherBLUE CROSS BLUE SHIELD
MAJ02988Medicare ID - Type Unspecified
B20061902OtherCIGNA