BLAZE KELLY (NPI# 1003445842) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003445842 |
| Entity Type | Individual |
| Full Name | BLAZE KELLY |
| Practice Address |
111 S 11th St Ste 8290 Philadelphia PA 19107-4824 |
| Practice Telephone | 2159552370 |
| Practice Fax Number | 2159550677 |
| Mailing Telephone | 2159552370 |
| Mailing Fax Number | 2159550677 |
| Enumeration Date | 2020-04-03 |
| Last Update Date | 2020-04-30 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | OT019937 | PA | Student, Health Care |
| Street Address |
111 S 11TH ST STE 8290 |
| City | PHILADELPHIA |
| State | PA |
| Zip Code | 19107-4824 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710366232 | Andrew Wong | Internal Medicine | 111 S 11th St Ste 8290, Philadelphia, PA 19107-4824 | 2015-05-29 |
| 1558990978 | Katherine Rose Dillon | Student in an Organized Health Care Education/Training Program | 111 S 11th St Ste 8290, Philadelphia, PA 19107-4824 | 2020-04-07 |
| 1144859778 | Matteo Petrera | Student in an Organized Health Care Education/Training Program | 111 S 11th St Ste 8290, Philadelphia, PA 19107-4824 | 2020-04-06 |
| 1609405364 | George Michael Kilzi | Student in an Organized Health Care Education/Training Program | 111 S 11th St Ste 8290, Philadelphia, PA 19107-4824 | 2020-04-05 |
| 1811526536 | Jordan Marie Stefko | Student in an Organized Health Care Education/Training Program | 111 S 11th St Ste 8290, Philadelphia, PA 19107-4824 | 2020-04-04 |
| 1104455948 | David Sweeney Rubin | Student in an Organized Health Care Education/Training Program | 111 S 11th St Ste 8290, Philadelphia, PA 19107-4824 | 2020-04-03 |
| 1104455955 | Shannon Haley | Student in an Organized Health Care Education/Training Program | 111 S 11th St Ste 8290, Philadelphia, PA 19107-4824 | 2020-04-03 |
| 1851920615 | Indra Neil Mukherjee | Student in an Organized Health Care Education/Training Program | 111 S 11th St Ste 8290, Philadelphia, PA 19107-4824 | 2020-04-03 |
| 1881223667 | Courtney Diane Singleton | Student in an Organized Health Care Education/Training Program | 111 S 11th St Ste 8290, Philadelphia, PA 19107-4824 | 2020-04-03 |
| 1568020170 | Natasha Rajiv Sinai Hede | Student in an Organized Health Care Education/Training Program | 111 S 11th St Ste 8290, Philadelphia, PA 19107-4824 | 2019-05-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578170940 | Stephanie Quist | Pharmacist | 1 S Broad Street, Philadelphia, PA 19107 | 2020-09-29 |
| 1457968448 | Cloudline Physical Therapy LLC | Physical Therapist | 239-241 South 10th St, Philadelphia, PA 19107 | 2020-09-24 |
| 1053931303 | Wilson Wong | Pharmacist | Cvs Pharmacy #450, 3401 Walnut St, Philadelphia, PA 19107 | 2020-04-16 |
| 1326608779 | Pascal Lavergne | Neurological Surgery | 111 11th St, Thomas Jefferson University, Philadelphia, PA 19107 | 2019-06-18 |
| 1639632185 | Taylor D'amore | Orthopaedic Surgery | 925 Chest Street 5th Floor, Philadelphia, PA 19107 | 2019-04-11 |
| 1043779630 | Heather Lynn Yenser | Nurse Practitioner | 111 S. 11th St., Jefferson Vascular Center (6th Floor), Philadelphia, PA 19107 | 2019-03-14 |
| 1174093702 | Jennifer Lynn Kengeter | Psychologist | 900 Walnut Street, Suite 200, Philadelphia, PA 19107 | 2018-11-27 |
| 1649751843 | Rachel Wint | Physician Assistant | 231 N Broad St Fl 2, Philadelphia, PA 19107 | 2018-08-24 |
| 1922588623 | Hyung Bin Lee | Dentist | 315 N 12th St, Apt 803, Philadelphia, PA 19107 | 2018-08-21 |
| 1750860490 | Anastasiya Khlypnych | Physician Assistant | 111 S. 11th Street, Suite 2170, Gibbon Bldg Suite 6210, Philadelphia, PA 19107 | 2018-08-13 |
| Find all providers in zip 19107 | ||||
| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639770829 | Michelle Morris | Student in an Organized Health Care Education/Training Program | Dept. of Family Medicine & Community Health, 3737 Market, Philadelphia, PA 19104 | 2020-11-04 |
| 1891395828 | Roopali Mahajan | Student in an Organized Health Care Education/Training Program | 4101 Spruce St Apt 108, Philadelphia, PA 19104-4059 | 2020-10-28 |
| 1629678925 | Jonathan Welch | Student in an Organized Health Care Education/Training Program | 4200 E City Ave, Rowland Hall, Suite 207, Physician Assistant Department, Philadelphia, PA 19131 | 2020-10-27 |
| 1477166056 | Tiffany Shanay Canady | Student in an Organized Health Care Education/Training Program | 8400 Lindbergh Blvd Apt 1011, Philadelphia, PA 19153-1513 | 2020-08-25 |
| 1093325599 | Taylor Ann Hall | Student in an Organized Health Care Education/Training Program | 403 E Evergreen Ave, Philadelphia, PA 19118-2826 | 2020-08-09 |
| 1093324766 | Alex J Rodriguez | Student in an Organized Health Care Education/Training Program | 7950 Henry Ave Apt 9a, Philadelphia, PA 19128-3005 | 2020-07-28 |
| 1396361796 | Hagar Mahmoud | Student in an Organized Health Care Education/Training Program | 9181 Academy Rd Apt 407, Philadelphia, PA 19114-2724 | 2020-06-22 |
| 1801412416 | Vishak Hari Kumar | Student in an Organized Health Care Education/Training Program | 2601 Holme Ave., Philadelphia, PA 19152 | 2020-06-19 |
| 1386266138 | Ogan Kumova | Student in an Organized Health Care Education/Training Program | 245 N 15th St Rm 18119, Philadelphia, PA 19102-1101 | 2020-05-15 |
| 1770104259 | Fatimah Sorefan-mangou | Student in an Organized Health Care Education/Training Program | 4 Maloney 3400 Spruce Street, Philadelphia, PA 19104 | 2020-05-06 |
| Find all providers in PHILADELPHIA | ||||
| City | PHILADELPHIA |
| Zip Code | 19107 |
Please comment or provide details below to improve the information on BLAZE KELLY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.