Provider Demographics
NPI:1619747367
Name:BLAIS, EDIK M (PHD)
Entity Type:Individual
Prefix:
First Name:EDIK
Middle Name:M
Last Name:BLAIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 GREENSBORO DR STE 900
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-4931
Mailing Address - Country:US
Mailing Address - Phone:703-286-0780
Mailing Address - Fax:
Practice Address - Street 1:8200 GREENSBORO DR STE 900
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-4931
Practice Address - Country:US
Practice Address - Phone:703-286-0780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-04
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZG1000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGeneticist, Medical (PhD)