Individual
MARK ANDREW BLAKESLEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3 HOSPITAL DR STE 212, LEWISBURG, PA 17837-9394
(570) 522-9771
(570) 522-9772
Mailing address
1 HOSPITAL DR STE 306, LEWISBURG, PA 17837-9350
(570) 522-4110
(570) 768-3911
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
OS007656L
PA
2084S0012X
Sleep Medicine (Psychiatry & Neurology) Physician
OS007656L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
118438711
DEPARTMENT OF LABOR
PA
01
—
170622
BLUE SHIELD
PA
05
—
18423860001
—
PA
01
—
232809429
TRICARE
PA
01
—
50002761
KEYSTONE
PA
01
—
645269046
GEISINGER
PA
01
—
G47849
HEALTH AMERICA
PA
01
—
P00170649
RAILROAD MEDICARE
PA
Enumeration date
07/18/2006
Last updated
06/07/2022
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