Provider Demographics
NPI:1063406171
Name:BLAKER, MARK E (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:E
Last Name:BLAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1729 BURRSTONE RD
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-1001
Mailing Address - Country:US
Mailing Address - Phone:315-798-1700
Mailing Address - Fax:315-798-1707
Practice Address - Street 1:1729 BURRSTONE RD
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-1001
Practice Address - Country:US
Practice Address - Phone:315-798-1700
Practice Address - Fax:315-798-1707
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2011-10-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY150221207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00729117Medicaid
B81884Medicare UPIN
RA0888Medicare ID - Type Unspecified