Provider Demographics
NPI:1740490663
Name:BLECHNER, LAURA LEE (PA-C)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LEE
Last Name:BLECHNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 RED TAIL CT
Mailing Address - Street 2:
Mailing Address - City:LIMERICK
Mailing Address - State:PA
Mailing Address - Zip Code:19468-1489
Mailing Address - Country:US
Mailing Address - Phone:610-746-8525
Mailing Address - Fax:
Practice Address - Street 1:4031 SHEFFIELD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19136-3101
Practice Address - Country:US
Practice Address - Phone:215-331-9940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2021-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002853L363A00000X
PAOA005732363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant