Healthcare Provider Details

I. General information

NPI: 1417452855
Provider Name (Legal Business Name): JAMES MICHAEL BLAIR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 S BROAD ST
PHILADELPHIA PA
19148-3542
US

IV. Provider business mailing address

211 S 9TH ST STE 300
PHILADELPHIA PA
19107-6810
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-8361
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD492543
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: