Provider Demographics
NPI:1326028424
Name:BLANK, IRA B (MD)
Entity type:Individual
Prefix:
First Name:IRA
Middle Name:B
Last Name:BLANK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 820137
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0137
Mailing Address - Country:US
Mailing Address - Phone:610-270-2352
Mailing Address - Fax:610-270-2358
Practice Address - Street 1:1301 POWELL ST
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-3323
Practice Address - Country:US
Practice Address - Phone:610-270-2717
Practice Address - Fax:610-270-2675
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026563L207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Not Answered207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2559705OtherAETNA HMO
PA0046559000OtherIBC - PC, KHPE
PAMD26563LOtherHEALTH PARTNERS
PA014338OtherHIGHMARK BLUE SHIELD
PA7222159OtherCIGNA HMO/PPO
PA1072341OtherKEYSTONE MERCY
PA4642402OtherAETNA PPO
PA0071056001OtherAMERICHOICE(UHC)
PA0046559000OtherAMERIHEALTH/INTERCOUNTY
PA350649OtherPHCS
PA4642402OtherAETNA PPO
PA014338Medicare ID - Type UnspecifiedHMR