Provider Demographics
NPI:1821380387
Name:RICHARD E BLAKE MD PA
Entity Type:Organization
Organization Name:RICHARD E BLAKE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-983-9366
Mailing Address - Street 1:8214 TUCKERMAN LN
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3744
Mailing Address - Country:US
Mailing Address - Phone:301-983-9366
Mailing Address - Fax:301-983-3283
Practice Address - Street 1:1111 SPRING ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4003
Practice Address - Country:US
Practice Address - Phone:301-608-9480
Practice Address - Fax:301-608-9088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD30235207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty