Individual
DR. KHASHANA A BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4692 BROWNSBORO RD, WINSTON SALEM, NC 27106
(336) 251-1114
(336) 251-1117
Mailing address
4692 BROWNSBORO RD, WINSTON SALEM, NC 27106-3410
(336) 251-1114
(336) 251-1117
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2009-01511
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1537W
BCBS
NC
05
—
5912215
—
NC
Enumeration date
06/01/2007
Last updated
10/15/2019
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