MEDICARE: LAWRENCE ANDREW BLELLOCH PA

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	101803	NC

General Provider Information

NPI Number	:	1245287416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAWRENCE ANDREW BLELLOCH PA

Provider Business Mailing Address
First Line	:	6512 SIX FORKS RD
Second Line	:	SUITE 102B
City	:	RALEIGH
State	:	NC
Zip	:	27615-6561
Country	:	US
Telephone Number	:	919-870-8845
Fax Number	:	919-870-8845

Provider Business Practice Location Address
First Line	:	6512 SIX FORKS RD
Second Line	:	SUITE 102B
City	:	RALEIGH
State	:	NC
Zip	:	27615-6561
Country	:	US
Telephone Number	:	919-870-8845
Fax Number	:	919-870-8845

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

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	07/09/2025

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