Provider Demographics
NPI:1124055231
Name:BLASIOL, JOSEPH (DO)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:BLASIOL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:TOPTON
Mailing Address - State:PA
Mailing Address - Zip Code:19562-1017
Mailing Address - Country:US
Mailing Address - Phone:610-682-7131
Mailing Address - Fax:610-682-2749
Practice Address - Street 1:72 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:TOPTON
Practice Address - State:PA
Practice Address - Zip Code:19562-1017
Practice Address - Country:US
Practice Address - Phone:610-682-7131
Practice Address - Fax:610-682-2749
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005104-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA196899Medicare ID - Type Unspecified
PAC29327Medicare UPIN