Healthcare Provider Details

I. General information

NPI: 1427313113
Provider Name (Legal Business Name): MELINA ALICE BLASI AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELINA ALICE ECOS AUD

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 10/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 N CHARLES ST PPE 601
BALTIMORE MD
21204-6800
US

IV. Provider business mailing address

6565 N CHARLES ST PPE 601
BALTIMORE MD
21204-6800
US

V. Phone/Fax

Practice location:
  • Phone: 410-821-5151
  • Fax: 410-823-8309
Mailing address:
  • Phone: 410-821-5151
  • Fax: 410-823-8309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number01260
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: