Blake, Michael Austin
Blake, Michael Austin is an individual health care provider with primary practice located at 55 Fruit St Ell 2 Radiological Associates, Boston MA 02114-2621. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Blake, Michael Austin can be contacted via phone (617) 726-8763.Contact Information
Primary practice address
55 Fruit St Ell 2 Radiological Associates
Boston MA 02114-2621
Phone: (617) 726-8763
Fax: (617) 726-4891
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | 159745 | Massachusetts |
Profile Details
| NPI number | 1871583039 |
|---|---|
| LBN Legal business name | Blake, Michael Austin |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 27th, 2005 |
| Last updated | Jul 8th, 2007 - about 17 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 | 1871583039 | NPPES |
| Massachusetts | Other | 159745 | TUFTS HEALTH PLAN |
| Massachusetts | MEDICAID | 0100811 | TUFTS HEALTH PLAN |
| Massachusetts | Other | J22412 | TUFTS HEALTH PLAN |
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