Healthcare Provider Details

I. General information

NPI: 1053722306
Provider Name (Legal Business Name): BLAIR SURRAN ASHLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2014
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E LANCASTER AVE STE 245
WYNNEWOOD PA
19096-3450
US

IV. Provider business mailing address

3803 W CHESTER PIKE STE 160
NEWTOWN SQUARE PA
19073-2336
US

V. Phone/Fax

Practice location:
  • Phone: 610-642-3005
  • Fax:
Mailing address:
  • Phone: 484-337-1530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD469949
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: