Provider Demographics
NPI:1720176381
Name:BLAKE, JAMES STEVEN (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:STEVEN
Last Name:BLAKE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5651
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-0651
Mailing Address - Country:US
Mailing Address - Phone:215-849-4902
Mailing Address - Fax:215-849-4907
Practice Address - Street 1:6827-31 GERMANTOWN AVENUE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119
Practice Address - Country:US
Practice Address - Phone:215-849-4902
Practice Address - Fax:215-849-4907
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007404E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2309047000OtherPERSONAL CHOICE
PA1037069OtherKMHP
PA163083OtherBLUE CROSS BLUE SHIELD
PA2309047000OtherKHPE
PA01461503OtherAMERICHOICE
PA1468415Medicaid
PA16956OtherHEALTH PARTNERS
PA1777074OtherUNITED
PA2126753OtherAETNA
PA2363719001OtherCIGNA
PAF85785Medicare UPIN