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Contact Information

KELSO L BLAZE
2530 N HOWARD ST UNIT 2
PHILADELPHIA, PA19133
 Phone: 732-744-4962
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for KELSO L BLAZE · (Female)

NPI # 1255096707
Status Active
Credentials
Entity Individual
Enumeration date 11/01/2021
Last updated 11/01/2021 - About 5 years ago
Sole proprietor 1 Yes
Identifiers
  • PA Medicaid 5306693119
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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