Provider Demographics
NPI:1174598155
Name:BLAIS, DAVID P (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:P
Last Name:BLAIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:830 KEMPSVILLE RD
Mailing Address - Street 2:1ST FL
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3920
Mailing Address - Country:US
Mailing Address - Phone:757-261-5283
Mailing Address - Fax:757-261-5849
Practice Address - Street 1:830 KEMPSVILLE RD
Practice Address - Street 2:1ST FL
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3920
Practice Address - Country:US
Practice Address - Phone:757-261-5283
Practice Address - Fax:757-261-5849
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2019-10-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101040001207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006026877Medicaid
B05288Medicare UPIN
VA006026877Medicaid