MEDICARE: DR. LAWRENCE F BLOB M.D.

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	D0021589	MD

General Provider Information

NPI Number	:	1720008576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE F BLOB M.D.

Provider Business Mailing Address
First Line	:	3131 CONNECTICUT AVE NW
Second Line	:	QA APT. # 2313
City	:	WASHINGTON
State	:	DC
Zip	:	20008-5000
Country	:	US
Telephone Number	:	410-262-1908
Fax Number	:

Provider Business Practice Location Address
First Line	:	3131 CONNECTICUT AVE NW
Second Line	:	QA APT. # 2313
City	:	WASHINGTON
State	:	DC
Zip	:	20008-5000
Country	:	US
Telephone Number	:	410-262-1908
Fax Number	:

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	03/22/2009

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