Individual
PETER JONATHAN BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
151 WORCESTER RD, BARRE, MA 01005-9002
(783) 556-3219
(978) 355-6549
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
(508) 334-1977
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA8403
MA
363AM0700X
Medical Physician Assistant
PA8403
MA
Other
Enumeration date
12/08/2019
Last updated
05/02/2023
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