Individual
CAROL VANDERPOEL BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
446 N READING RD, EPHRATA, PA 17522-9802
(717) 738-4334
Mailing address
3421 CONCORD RD, YORK, PA 17402-9001
(717) 738-4334
(717) 738-3289
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA055489
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
240558UFW
MEDICARE PTAN
PA
Enumeration date
02/06/2007
Last updated
06/08/2020
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