Provider Demographics
NPI:1952298754
Name:BASKIN, BLAKE JOHN (PA-C)
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:JOHN
Last Name:BASKIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 SHALLOW BROOK WAY
Mailing Address - Street 2:
Mailing Address - City:SUFFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06078-1240
Mailing Address - Country:US
Mailing Address - Phone:860-729-2305
Mailing Address - Fax:
Practice Address - Street 1:98 SHAKER RD
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-2731
Practice Address - Country:US
Practice Address - Phone:413-798-0301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant