Provider Demographics
NPI:1659318459
Name:BLANK, ARNOLD J (MD)
Entity Type:Individual
Prefix:DR
First Name:ARNOLD
Middle Name:J
Last Name:BLANK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 PLEASANT ST
Mailing Address - Street 2:#13
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-8123
Mailing Address - Country:US
Mailing Address - Phone:781-322-3005
Mailing Address - Fax:781-322-1394
Practice Address - Street 1:380 PLEASANT ST
Practice Address - Street 2:#13
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-8123
Practice Address - Country:US
Practice Address - Phone:781-322-3005
Practice Address - Fax:781-322-1394
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA242708207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400004122Medicare PIN
NYB58693Medicare UPIN
NY45J511Medicare ID - Type Unspecified
NY9255ALMedicare ID - Type Unspecified
NYA400006568Medicare PIN