Michael Clarence Blake, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

0101023774 Issued in VA

Practice address

2790 Godwin Blvd
Ste 305
Suffolk, VA 23434-8151

Phone

(757) 934-4222

Fax

(757) 934-4111

NPI assigned

Apr 5, 2006

Last updated

Nov 13, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352764800000",
    "number": "1063474955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2790 GODWIN BLVD",
            "address_2": "STE 305",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234348151",
            "telephone_number": "757-934-4222",
            "fax_number": "757-934-4111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2790 GODWIN BLVD",
            "address_2": "STE 305",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234348151",
            "telephone_number": "757-934-4222",
            "fax_number": "757-934-4111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "MICHAEL",
        "middle_name": "CLARENCE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-05",
        "last_updated": "2012-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "VA",
            "license": "0101023774",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca Bishop, COTA/L
• James Graham Bittner IV, MD
• Randall L Bittner, DMD
• Melanie Bjorkman, FNP-C
• Myria Gunn Black, NP-C
• Samantha Diane Blake, CCC-SLP
• Blakey Weaver Counseling Center Inc
• Leigh J Blakiston, DDS
• Melody Blanco, FNP
• Blessed Keepers Home Health Care

• Surgery Physician in Suffolk, VA
• Providers in Suffolk, VA by specialty
• Surgery Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.