Individual
JACOB R. BLEDSOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
300 LONGWOOD AVE, BOSTON, MA 02115-5724
(617) 355-6000
Mailing address
300 LONGWOOD AVE, BOSTON, MA 02115-5724
(617) 355-6000
Taxonomy
Speciality
Code
Description
License number
State
207ZH0000X
Hematology (Pathology) Physician
261670
MA
207ZP0101X
Anatomic Pathology Physician
261670
MA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
261670
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110112394A
—
MA
Enumeration date
06/07/2011
Last updated
01/08/2021
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