Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 0101241616 | VA |
N | 208600000X | Surgeon | 0101241616 | VA |
N | 208200000X | Surgeon | 61499 | CT |
N | 208600000X | Surgeon | 61499 | CT |
Y | 2086S0102X | Surgical Critical Care | 0101241616 | VA |
N | 2086S0102X | Surgical Critical Care | 35.093895 | OH |
N | 2086S0102X | Surgical Critical Care | 61499 | CT |
N | 2086S0127X | Trauma Surgeon | 0101241616 | VA |
N | 2086S0127X | Trauma Surgeon | 35.093895 | OH |
N | 2086S0127X | Trauma Surgeon | 61499 | CT |
NPI | 1063484210 |
---|---|
Provider Name | Dr. David Paul Blake |
First Address | Hartford, CT 06106-5523 |
Second Address | Falls Church, VA 22042-3307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2006 |
Last Update Date | 20/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10106541 | OPTIMA HEALTH (01) | VA |
1063484210 | (05) | NC |
1063484210 | (05) | VA |
1063484210 | COVENTRY HEALTH NETWORK (01) | VA |
1063484210 | UNITED HEALTHCARE (01) | VA |
488414 | ANTHEM BC/BS (01) | VA |
PAR | AETNA (01) | VA |
PAR | CIGNA (01) | VA |
PAR | CORVEL (01) | VA |
PAR | MULTIPLAN (01) | VA |
PAR | USA MANAGED CARE (01) | VA |
PAR | VIRGINIA HEALTH NETWORK (01) | VA |