Active NPI
Gonzalo Blasi, DDS MS
- Periodontics
- Baltimore, MD
National Provider Identifier
1407396369
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 0401415436
- Practice address
- 305 W Fayette St Apt 1412
Baltimore, MD 21201-3466 - Phone
- (443) 980-8835
- NPI assigned
- Feb 26, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 0401415436 | VA | Primary |
Addresses
Primary practice location
305 W Fayette St Apt 1412
Baltimore, MD 21201-3466
Mailing address
305 W Fayette St Apt 1412
Baltimore, MD 21201-3466
Phone (443) 980-8835
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0401415436 | VA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1488067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1488067200000",
"number": "1407396369",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "305 W FAYETTE ST APT 1412",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212013466",
"telephone_number": "443-980-8835"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "305 W FAYETTE ST APT 1412",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212013466",
"telephone_number": "443-980-8835"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLASI",
"first_name": "GONZALO",
"name_prefix": "Dr.",
"credential": "DDS MS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-02-26",
"last_updated": "2017-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "VA",
"license": "0401415436",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.