Healthcare Provider Details

I. General information

NPI: 1619522018
Provider Name (Legal Business Name): MARIE K BLASI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2019
Last Update Date: 08/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 IRVING ST NW
WASHINGTON DC
20010-2921
US

IV. Provider business mailing address

7647 HILLSIDE DR
VICTOR NY
14564-8928
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-1152
  • Fax:
Mailing address:
  • Phone: 585-690-3405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: