Individual
DR. DOREEN BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1450 MERCANTILE LN, SUITE 111, LARGO, MD 20774-5376
(301) 925-7610
Mailing address
P.O. BOX 12622, BELFAST, ME 04915-4017
(443) 481-6580
(443) 481-6515
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
D39421
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
116600000
—
MD
01
—
P01298022
RR MEDICARE
—
Enumeration date
10/19/2005
Last updated
06/04/2014
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