Healthcare Provider Details

I. General information

NPI: 1548703556
Provider Name (Legal Business Name): BLA PARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2016
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 COMMUNITY DR SUITE 2
SOUTH BURLINGTON VT
05403-6834
US

IV. Provider business mailing address

530 COMMUNITY DR. SUITE 2
SOUTH BURLINGTON VT
05403-6834
US

V. Phone/Fax

Practice location:
  • Phone: 802-863-4105
  • Fax:
Mailing address:
  • Phone: 802-863-4105
  • Fax: 802-448-3196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: CHERIAN PHILIP
Title or Position: CFO
Credential:
Phone: 802-391-0476