Provider Demographics
NPI:1871682468
Name:BLASS, DAVID C (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:BLASS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:261 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-8081
Mailing Address - Country:US
Mailing Address - Phone:724-439-1020
Mailing Address - Fax:724-434-5485
Practice Address - Street 1:261 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-8081
Practice Address - Country:US
Practice Address - Phone:304-216-0816
Practice Address - Fax:304-216-0816
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD014013E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010549730006Medicaid
PA118130Medicare PIN
PA0010549730006Medicaid