MEDICARE: IRA JAY BLEIWEISS MD

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	207ZP0105X	Clinical Pathology/Laboratory Medicine Physician	MD034904E	PA
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	MD034904E	PA

General Provider Information

NPI Number	:	1851399869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRA JAY BLEIWEISS MD

Provider Business Mailing Address
First Line	:	800 SPRUCE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-6130
Country	:	US
Telephone Number	:	215-829-3000
Fax Number	:	215-829-7564

Provider Business Practice Location Address
First Line	:	800 SPRUCE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-6130
Country	:	US
Telephone Number	:	215-829-3000
Fax Number	:	215-829-7564

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	10/24/2019

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