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:
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Health care specialties

SpecialtyCodeLicense #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 10 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1043209331 NPPES
Maryland MEDICAID 116600000
Maryland Other P01298022

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