Andrew Lee Blalock, IDC
Individual provider Active NPI Independent Duty Corpsman · Niantic, CT
NPI 1447557657 · NPPES record last updated Feb 24, 2011
Key facts
- NPI
- 1447557657
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Independent Duty Corpsman 1710I1002X
- Practice address
- 97 W Main St
Apt 47
Niantic, CT 06357-1749 - Phone
- (305) 492-5489
- NPI assigned
- Feb 24, 2011
- 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 |
|---|---|---|---|---|
| Independent Duty Corpsman | 1710I1002X | Yes |
Addresses
Primary practice location
97 W Main St
Apt 47
Niantic, CT 06357-1749
Mailing address
97 West Main St
Apt 47
Niantic, CT 06357-1731
Phone (305) 492-5489
Other providers in Niantic, CT
- Benchmark Assisted Living LLC
- Benchmark Assisted Living LLC
- Luanne Benshimol
- Better Vision LLC
- Kenneth Michael Bibalo
- Suzanne Marie Bondy
- Leah Langford Booth
- Laura Jean Brewster
- Bride Brook SNF Operations LLC
- Jessie M.E. Brutus
All providers in Niantic, CT · Independent Duty Corpsman in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 24, 2011. 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.