Provider Demographics
NPI:1205898772
Name:MARSON, BLAKE M (MD)
Entity type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:M
Last Name:MARSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1301 TRUMANSBURG RD
Mailing Address - Street 2:SUITE P
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1397
Mailing Address - Country:US
Mailing Address - Phone:607-277-2365
Mailing Address - Fax:607-277-1415
Practice Address - Street 1:1122 COMMONS AVE
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-1643
Practice Address - Country:US
Practice Address - Phone:607-428-8004
Practice Address - Fax:607-428-8003
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2016-07-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY219213207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02099829Medicaid
NYG18001Medicare UPIN
NYDD1069Medicare ID - Type UnspecifiedUPSTATE