DataLabs

datalabs.health made in the usa

Contact us Sign in | Documentation |

divider

Medicare/Medicaid Verification Programs divider

divider

Medicare Verification Program divider

divider

1134222458

NPI Code Detail

MEDICARE: KENT WILLIAM BLAKELY MD

MEDICARE: KENT WILLIAM BLAKELY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	G162755	CA
2	207RR0500X	Rheumatology Physician	MD042525L	PA
3	207RR0500X	Rheumatology Physician	MD60640236	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MD042525L	OTHER	PA	STATE LICENSE
2	MD60640236	OTHER	WA	STATE LICENSE
3	MED-PHYS-COM-LIC-112	OTHER	MT	STATE LICENSE

General Provider Information

NPI Number	:	1134222458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENT WILLIAM BLAKELY MD

Provider Business Mailing Address
First Line	:	14324 52ND AVE W UNIT B
Second Line	:
City	:	EDMONDS
State	:	WA
Zip	:	98026-3803
Country	:	US
Telephone Number	:	425-951-0704
Fax Number	:

Provider Business Practice Location Address
First Line	:	675 BALTIMORE DR
Second Line	:
City	:	WILKES BARRE
State	:	PA
Zip	:	18702-7900
Country	:	US
Telephone Number	:	800-275-6401
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	02/09/2026

Similar Medicare Providers

1356344626 — DR. BRIAN B BRUGGEMAN MD
Practice Location Address:

675 BALTIMORE DR
WILKES BARRE, PA
18702-7900

Practice Phone: 570-808-6400
Practice Fax: 570-808-6338

1750386066 — DR. DAVID WILLIAM ADCOCK M.D.
Practice Location Address:

675 BALTIMORE DR
WILKES BARRE, PA
18702-7900

Practice Phone: 570-808-6400
Practice Fax: 570-808-6338

1376543991 — STACY J CONWAY OD
Practice Location Address:

675 BALTIMORE DR
WILKES BARRE, PA
18702-7900

Practice Phone: 570-808-5441
Practice Fax: 570-808-5371

1730161621 — JAMES DALTON HAYES II MD
Practice Location Address:

675 BALTIMORE DR
WILKES BARRE, PA
18702-7900

Practice Phone: 570-808-7923
Practice Fax:

1710963905 — MARGOT E. CLASQUIN M.D.
Practice Location Address:

675 BALTIMORE DR
WILKES BARRE, PA
18702-7900

Practice Phone: 570-808-7923
Practice Fax: 570-808-6337

1477527356 — MS. DEBORAH BAIRD PA-C
Practice Location Address:

675 BALTIMORE DR
WILKES BARRE, PA
18702-7900

Practice Phone: 570-808-5780
Practice Fax: 570-808-5753

Directions to “ KENT WILLIAM BLAKELY MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.