Provider Demographics
NPI:1285724526
Name:BLEY, LOUIS A (MD)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:A
Last Name:BLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:40 HOLLAND ST DEPT 9TH
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2705
Mailing Address - Country:US
Mailing Address - Phone:617-654-7111
Mailing Address - Fax:617-629-6248
Practice Address - Street 1:40 HOLLAND ST DEPT 9TH
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2705
Practice Address - Country:US
Practice Address - Phone:617-654-7111
Practice Address - Fax:617-629-6248
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA209427207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0030342OtherNEIGHBORHOOD HEALTH
MA3202277004OtherCIGNA
MD011004OtherTUFTS HEALTH PLAN
MDJ24425OtherBLUE CROSS BLUE SHIELD
MA173946OtherHARVARD PILGRIM
MA3202277004OtherHEALTHSOURCE
MA2013690Medicaid
MAA3256601Medicare PIN
MD011004OtherTUFTS HEALTH PLAN