Provider Demographics
NPI:1720625759
Name:BLAIR FOOT AND ANKLE LLC
Entity Type:Organization
Organization Name:BLAIR FOOT AND ANKLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:O
Authorized Official - Last Name:COREY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-404-2752
Mailing Address - Street 1:1798 PLANK RD STE 201
Mailing Address - Street 2:
Mailing Address - City:DUNCANSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16635-8389
Mailing Address - Country:US
Mailing Address - Phone:814-696-3397
Mailing Address - Fax:814-696-9477
Practice Address - Street 1:1798 PLANK RD STE 201
Practice Address - Street 2:
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635-8389
Practice Address - Country:US
Practice Address - Phone:814-696-3397
Practice Address - Fax:814-696-9477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty