=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396709952
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BLESSY METHIKALAM MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2006
-----------------------------------------------------
Last Update Date | 06/06/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 131 E CHELTEN AVE
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19144-2153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-685-5723
-----------------------------------------------------
Fax | 215-685-5791
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 35 CHAPEL HILL RD
-----------------------------------------------------
City | HUNTINGDON VALLEY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19006-7913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-938-0257
-----------------------------------------------------
Fax | 215-938-0257
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | MD421801
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------