Provider Demographics
NPI:1710987979
Name:BLAZEK-O'NEILL, BETSY W (MD)
Entity Type:Individual
Prefix:DR
First Name:BETSY
Middle Name:W
Last Name:BLAZEK-O'NEILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 S JACKSON AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15202-3428
Mailing Address - Country:US
Mailing Address - Phone:412-359-8951
Mailing Address - Fax:412-734-7795
Practice Address - Street 1:100 S JACKSON AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15202-3428
Practice Address - Country:US
Practice Address - Phone:412-359-8951
Practice Address - Fax:412-734-7795
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD044471L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001686719Medicaid
10923243OtherCAQH
PAF24136Medicare UPIN