Individual
MR. BLAKE VICENT IRELAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
158 HARMON DR, NORTHFIELD, VT 05663-1000
(203) 565-1815
Mailing address
93 DIXIE AVE, WATERBURY, CT 06706-1604
(203) 757-0636
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
07/18/2017
Last updated
07/18/2017
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