MEDICARE: MT. AIRY ANESTHESIOLOGY ASSOCIATES, LLC

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	174400000X	Specialist
2	174400000X	Specialist		PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437363512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MT. AIRY ANESTHESIOLOGY ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	P.O. BOX 5651
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19129
Country	:	US
Telephone Number	:	215-849-4902
Fax Number	:	215-849-4907

Provider Business Practice Location Address
First Line	:	6827-31 GERMANTOWN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19119-2113
Country	:	US
Telephone Number	:	215-849-4902
Fax Number	:	215-849-4902

Authorized Official
Title or Position	:	CEO/MEDICAL DIRECTOR
Name	:	DR. JAMES STEVEN BLAKE
Credential	:	D.O.
Telephone Number	:	215-849-4902

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	06/03/2011

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