Individual
DR. MICHAEL AUSTIN BLAKE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 FRUIT ST, ELL 2 RADIOLOGICAL ASSOCIATES, BOSTON, MA 02114-2621
(617) 726-8763
(617) 726-4891
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(617) 724-0287
(617) 726-2894
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
159745
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0100811
—
MA
01
—
159745
TUFTS HEALTH PLAN
MA
01
—
J22412
BCBS MA
MA
Enumeration date
10/27/2005
Last updated
07/08/2007
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