Healthcare Provider Details

I. General information

NPI: 1407981566
Provider Name (Legal Business Name): BLAIR MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 08/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PENNSYLVANIA AVE
TYRONE PA
16686-1728
US

IV. Provider business mailing address

1414 9TH AVE STATION MEDICAL CENTER
ALTOONA PA
16602-2415
US

V. Phone/Fax

Practice location:
  • Phone: 814-684-2100
  • Fax: 814-684-5828
Mailing address:
  • Phone: 814-946-1655
  • Fax: 814-949-7616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER L. BRYAN
Title or Position: PROJECTS MGR.
Credential:
Phone: 814-949-7621