MEDICARE: KELSO LYNNE-BORRELL BLAZE

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

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	:	1255096707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSO LYNNE-BORRELL BLAZE

Provider Business Mailing Address
First Line	:	2530 N HOWARD ST UNIT 2
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19133
Country	:	US
Telephone Number	:	732-744-4962
Fax Number	:

Provider Business Practice Location Address
First Line	:	2530 N HOWARD ST UNIT 2
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19133
Country	:	US
Telephone Number	:	732-744-4962
Fax Number	:

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

Provider Enumeration Date	:	11/01/2021
Last Update Date	:	11/01/2021

Similar Medicare Providers

1518764786 — ALLIED COMFORT N CARE OUTPATIENT MENTAL HEALTH CLINIC
Practice Location Address:

236 W ALLEGHENY AVE
PHILADELPHIA, PA
19133-3629

Practice Phone: 215-989-1771
Practice Fax:

1457820805 — PAOLA DAZA NUNEZ MD
Practice Location Address:

401 W ALLEGHENY AVE
PHILADELPHIA, PA
19133-3647

Practice Phone: 215-291-2500
Practice Fax:

1225536568 — DELAWARE VALLEY COMMUNITY HEALTH, INC.
Practice Location Address:

400 W ALLEGHENY AVE BLDG 5B
PHILADELPHIA, PA
19133-3639

Practice Phone: 215-291-2500
Practice Fax: 215-291-2582

1114940582 — DELAWARE VALLEY COMMUNITY HEALTH, INC.
Practice Location Address:

401-55 W ALLEGHENY AVE
PHILADELPHIA, PA
19133-3644

Practice Phone: 215-291-2500
Practice Fax: 215-291-2587

1235956921 — DELAWARE VALLEY COMMUNITY HEALTH, INC.
Practice Location Address:

2600 N AMERICAN ST
PHILADELPHIA, PA
19133-3413

Practice Phone: 215-291-2500
Practice Fax:

1710572136 — UNITED CAREGIVERS, LLC
Practice Location Address:

2921 N 5TH ST
PHILADELPHIA, PA
19133-2800

Practice Phone: 267-680-8877
Practice Fax:

1154276558 — THE ROOTS FOR HOPE
Practice Location Address:

1128 W DAUPHIN ST FL 2
PHILADELPHIA, PA
19133-1018

Practice Phone: 215-303-5942
Practice Fax:

Directions to “ KELSO LYNNE-BORRELL BLAZE ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.