Provider Demographics
NPI:1124091871
Name:BLINN, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BLINN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 LINCOLN AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BELLEVUE
Mailing Address - State:PA
Mailing Address - Zip Code:15202-3550
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:575 LINCOLN AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:BELLEVUE
Practice Address - State:PA
Practice Address - Zip Code:15202-3550
Practice Address - Country:US
Practice Address - Phone:412-761-5535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036261E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012769080007Medicaid
PAF20831Medicare UPIN
PA0012769080007Medicaid
PA715461R7RMedicare PIN
PAP00042003Medicare PIN