MEDICARE: LINDSEY CARLTON BLAKE 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	2085N0700X	Neuroradiology Physician	7430	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	300059138	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	NV7305	OTHER	NV	BLUE

General Provider Information

NPI Number	:	1720066921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSEY CARLTON BLAKE M.D.

Provider Business Mailing Address
First Line	:	1 INDEPENDENCE PT STE 202
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-4536
Country	:	US
Telephone Number	:	877-406-2916
Fax Number	:

Provider Business Practice Location Address
First Line	:	3061 S MARYLAND PKWY
Second Line	:	SUITE 102
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-2298
Country	:	US
Telephone Number	:	702-731-2888
Fax Number	:	702-696-9289

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

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	01/11/2013

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Directions to “ LINDSEY CARLTON BLAKE M.D.” Practice Location

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