MEDICARE: BLAKE & SLOAN PC

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	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CIGNA	OTHER	MD	CIGNA
2	KCT4BL	OTHER	MD	CAREFIRST - MD
3	0478-0003	OTHER	DC	CAREFIRST-FED - DR. SLOAN
4	04780002	OTHER	DC	CAREFIRST-FED - DR BLAKE

General Provider Information

NPI Number	:	1598885436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLAKE & SLOAN PC

Provider Business Mailing Address
First Line	:	1450 MERCANTILE LN
Second Line	:	SUITE 111
City	:	LARGO
State	:	MD
Zip	:	20774-5376
Country	:	US
Telephone Number	:	301-925-7610
Fax Number	:	301-925-7619

Provider Business Practice Location Address
First Line	:	1450 MERCANTILE LN
Second Line	:	SUITE 111
City	:	LARGO
State	:	MD
Zip	:	20774-5376
Country	:	US
Telephone Number	:	301-925-7610
Fax Number	:	301-925-7619

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	ALEX A TORRES
Credential	:
Telephone Number	:	703-684-4581

Provider Enumeration Date	:	03/31/2007
Last Update Date	:	08/22/2020

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Directions to “BLAKE & SLOAN PC ” Practice Location

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