Blake, Doreen
Blake, Doreen is an individual health care provider with primary practice located at 1450 Mercantile Ln Suite 111, Largo MD 20774-5376. She recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as her primary health care specialty. Blake, Doreen can be contacted via phone (301) 925-7610.Contact Information
Primary practice address
1450 Mercantile Ln Suite 111
Largo MD 20774-5376
Phone: (301) 925-7610
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | D39421 | Maryland |
Profile Details
| NPI number | 1043209331 |
|---|---|
| LBN Legal business name | Blake, Doreen |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 19th, 2005 |
| Last updated | Jun 4th, 2014 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1043209331 | NPPES |
| Maryland | MEDICAID | 116600000 | |
| Maryland | Other | P01298022 |
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