MEDICARE: DAVID CORLEY BLEASE PA-C

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	363A00000X	Physician Assistant	A875	SC
2	363AS0400X	Surgical Physician Assistant	A875	SC

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

General Provider Information

NPI Number	:	1225057086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID CORLEY BLEASE PA-C

Provider Business Mailing Address
First Line	:	9313 MEDICAL PLAZA DR
Second Line	:	SUITE 304
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-9155
Country	:	US
Telephone Number	:	843-553-5616
Fax Number	:	843-764-2917

Provider Business Practice Location Address
First Line	:	9313 MEDICAL PLAZA DR
Second Line	:	SUITE 304
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-9155
Country	:	US
Telephone Number	:	843-553-5616
Fax Number	:	843-764-2917

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	02/01/2022

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Directions to “ DAVID CORLEY BLEASE PA-C” Practice Location

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