Provider Demographics
NPI:1255399440
Name:BLASS, DEAN ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:DEAN
Middle Name:ALAN
Last Name:BLASS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 THERESA RD
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2011
Mailing Address - Country:US
Mailing Address - Phone:781-595-4544
Mailing Address - Fax:
Practice Address - Street 1:225 BOSTON ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01904-3137
Practice Address - Country:US
Practice Address - Phone:781-595-4544
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA55164174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAD17048OtherBLUE SHIELD ID NUMBER
MA2092239Medicaid
BLD17048Medicare ID - Type Unspecified
MAD17048OtherBLUE SHIELD ID NUMBER