Individual
JESUS BLANCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
104 WHALON ST, SUITE 108, FITCHBURG, MA 01420-7128
(978) 342-1150
(978) 342-4530
Mailing address
PO BOX 395, WESTMINSTER, MA 01473-0395
(603) 673-9411
(603) 673-9899
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
56301
MA
207RP1001X
Pulmonary Disease Physician
56301
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3040101
—
MA
01
—
B75029
UPIN
—
Enumeration date
05/01/2006
Last updated
02/04/2015
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