Healthcare Provider Details

I. General information

NPI: 1285128405
Provider Name (Legal Business Name): OLIVIA BLAZEK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 N. 39TH STREET
PHILADELPHIA PA
19104-2640
US

IV. Provider business mailing address

1800 N. CAPITOL AVENUE E371
INDIANAPOLIS IN
46202
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-9990
  • Fax:
Mailing address:
  • Phone: 610-291-7953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA13179700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD495386
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: