Organization
BLAIR MEDICAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER L BRYAN (PROJECTS MGR.)
(814) 949-7621
Entity
Organization
Contact information
Practice address
149 DEVILLE DRIVE, DUNCANSVILLE, PA 16635
(814) 693-0628
(814) 693-0637
Mailing address
1414 9TH AVE, STATION MEDICAL CENTER, ALTOONA, PA 16602-2415
(814) 946-1655
(814) 949-7616
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007393100024
—
PA
05
—
1007393100025
—
PA
01
—
1508647
GATEWAY FP NUMBER
PA
01
—
1530694
GATEWAY PEDS NUMBER
PA
01
—
W442
GEISINGER OFFICE NO
PA
Enumeration date
02/15/2007
Last updated
10/22/2012
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