Provider Demographics
NPI:1760421655
Name:SO, BLESILDA S (MD)
Entity Type:Individual
Prefix:
First Name:BLESILDA
Middle Name:S
Last Name:SO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:15 S MAIN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-6636
Mailing Address - Country:US
Mailing Address - Phone:716-483-3520
Mailing Address - Fax:716-483-3593
Practice Address - Street 1:15 S MAIN ST
Practice Address - Street 2:SUITE 130
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-6636
Practice Address - Country:US
Practice Address - Phone:716-483-3520
Practice Address - Fax:716-483-3593
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2016-02-18
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Provider Licenses
StateLicense IDTaxonomies
NY227236207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2360098Medicaid
NYJ400168913OtherMEDICARE PTAN
NYG11999Medicare UPIN