Provider Demographics
NPI:1952490732
Name:ZEBEDE BLANK, MARCELA (MD)
Entity Type:Individual
Prefix:
First Name:MARCELA
Middle Name:
Last Name:ZEBEDE BLANK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 LINCOLN AVENUE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5708
Mailing Address - Country:US
Mailing Address - Phone:401-225-7522
Mailing Address - Fax:401-732-1592
Practice Address - Street 1:455 TOLL GATE ROAD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886
Practice Address - Country:US
Practice Address - Phone:401-737-7010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD10179207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9020925Medicaid
RI0000021209OtherBLUE CROSS BLUE SHIELD
RI9020925Medicaid