Provider Demographics
NPI:1720491517
Name:CHI, BLAISE
Entity Type:Individual
Prefix:
First Name:BLAISE
Middle Name:
Last Name:CHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 METZEROTT RD
Mailing Address - Street 2:APT 17
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-5154
Mailing Address - Country:US
Mailing Address - Phone:240-383-2232
Mailing Address - Fax:
Practice Address - Street 1:1814 METZEROTT RD
Practice Address - Street 2:APT 17
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783-5154
Practice Address - Country:US
Practice Address - Phone:240-383-2232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA10570374U00000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker