Individual
BLAKE ERIC CHRISTIANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
525 E 68TH ST, NEW YORK, NY 10065-4870
(478) 719-4436
Mailing address
PO BOX 1190, LAWRENCEVILLE, GA 30046-1190
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
300135
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/28/2018
Last updated
11/19/2024
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