Blake Vicent Ireland
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Northfield, VT
NPI 1154844504 · NPPES record last updated Jul 18, 2017
Key facts
- NPI
- 1154844504
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 158 Harmon Dr
Northfield, VT 05663-1000 - Phone
- (203) 565-1815
- NPI assigned
- Jul 18, 2017
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Yes |
Addresses
Primary practice location
158 Harmon Dr
Northfield, VT 05663-1000
Mailing address
93 Dixie Ave
Waterbury, CT 06706-1604
Phone (203) 757-0636
Other providers in Northfield, VT
- Peter Bert Henry
- Timothy Hodges Jr.
- Jessica Boucher Hurlbert
- Lisa Eve Hurwitz
- Donald F Hutchins
- Abigail Joyal
- Emma Kirn
- Ray J. Kunkel
- Daniel Walter Lavin
- Kari Little
All providers in Northfield, VT · Student in an Organized Health Care Education/Training Program in Vermont
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 18, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.