Organization
BLAKE MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SARAH BLAKE MD (PRESIDENT)
(718) 541-1864
Entity
Organization
Contact information
Practice address
3 WOODLAND RD STE 318, STONEHAM, MA 02180-1713
(617) 939-1602
(458) 201-6005
Mailing address
36 CENTRE LN, MILTON, MA 02186-3912
(718) 541-1864
(458) 201-6005
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
208VP0000X
Pain Medicine Physician
Primary
—
—
261QP3300X
Pain Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1100850080A
—
MA
Enumeration date
10/08/2018
Last updated
02/26/2019
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