MEDICARE: JOEL MITCHELL BLASS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	2016-00926	NC
2	207R00000X	Internal Medicine Physician	166612	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154429850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL MITCHELL BLASS MD

Provider Business Mailing Address
First Line	:	90 SOUTHSIDE AVE STE 350
Second Line	:
City	:	ASHEVILLE
State	:	NC
Zip	:	28801-4184
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2920 FORESTVILLE RD STE 100
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27616-8774
Country	:	US
Telephone Number	:	860-882-7525
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	10/06/2023

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