Dr. Diane R Blake
M.D. | Pediatric Adolescent Medicine | Female
Dr. Diane R Blake, M.D. is a Worcester, Massachusetts based Pediatric doctor with medical specialization in
Pediatric Adolescent Medicine. Dr. Diane R Blake is also known as
Diane R Blake-johnson.
Current practice location of Dr. Diane R Blake is
55 Lake Ave N, Department Of Adolescent Medicine, Worcester, Massachusetts - 01655-0002. She can be contacted on phone at
508-856-5624.
Dr. Diane R Blake is a sole proprietor of her business.
NPI number (Unique professional ID) for Dr. Diane R Blake is
1316921182 which was assigned by NPPES on 05 Dec, 2005 and it was last updated on 10 Nov, 2020.
Dr. Diane R Blake license number is
154470 for Pediatrics Adolescent Medicine (2080A0000X) in Massachusetts.
Dr. Diane R Blake specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs.
Complete Profile:
Dr. Diane R Blake basic information including her official name, gender, specialization, credentials etc. are as mentioned below.
| Specialization : | Pediatrics Adolescent Medicine |
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| Provider Name : | Dr. Diane R Blake |
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| Other Name : | Diane R Blake-johnson |
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| Credential : | M.D. |
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| Gender : | Female |
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Business Address:
Dr. Diane R Blake address, contact phone number and fax are as below. Patients can directly walkin to the clinic or can call on the below given phone number for appointment.
| Primary Address : | 55 Lake Ave N, Department Of Adolescent Medicine
Worcester, MA, 01655-0002
United States |
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| Phone Number : | 508-856-5624 |
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Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). NPI details are as mentioned below.
| NPI Number : | 1316921182 |
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| NPI Entity Type : | Individual |
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| First Enrolment Date : | 05 Dec, 2005 |
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| Last Updated On : | 10 Nov, 2020 |
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Licenses and Specialities:
Physicians/Organizations can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Dr. Diane R Blake are as mentioned. Primary taxonomy code for Dr. Diane R Blake, M.D. is
2080A0000X (Pediatrics Adolescent Medicine).
| Taxonomy Code | Speciality | Primary | License No. | State |
|---|
| 2080A0000X | Pediatrics Adolescent Medicine | Yes | 154470 | MA |
Legacy Identifiers:
Other legacy medical identifiers of Dr. Diane R Blake such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned below.
| Identifier | Identifier Type | State | Issuer |
|---|
| 3169863 | MEDICAID | MA | |
Endpoints:
Endpoints provide a simple, secure, scalable, and standards-based way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the Internet. It is used by EHR systems (Electronic Health Records).
| Endpoint Type | Endpoint | Affiliation | Use | Content | Address |
|---|
DIRECT
(Direct Messaging Address) | dblake22229@UmassMemorial.direct-ci.com
| No affiliation |
|
| 55 LAKE AVE N, DEPARTMENT OF ADOLESCENT MEDICINE
WORCESTER, MA, 01655-0002
United States |
FHIR
(FHIR URL) | https://epicproxy.et0978.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
| No affiliation |
|
| 55 LAKE AVE N, DEPARTMENT OF ADOLESCENT MEDICINE
WORCESTER, MA, 01655-0002
United States |
Mailing Address:
Mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned business address only.
| Mailing Address : | Po Box 62, Turnpike Station
Shrewsbury, MA, 01545-0062
United States |
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| Phone Number : | 508-334-8815 |
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| Fax Number : | 508-334-5374 |
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Business Location:
Patients can refer following map for directions to
Dr. Diane R Blake practice address. Don't forget to take prior appointment before visiting.
** Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on 08 January, 2024.