Provider Demographics
NPI:1427139922
Name:BLAMASAH, VERONICA (MHS, PA-C)
Entity type:Individual
Prefix:MS
First Name:VERONICA
Middle Name:
Last Name:BLAMASAH
Suffix:
Gender:F
Credentials:MHS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 STATION AVE APT D34
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-7153
Mailing Address - Country:US
Mailing Address - Phone:215-244-6353
Mailing Address - Fax:
Practice Address - Street 1:3400 SPRUCE STREET, 2 DULLES
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-746-6498
Practice Address - Fax:215-615-1602
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA-051602363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA051602OtherLICENSE NUMBER
0832088ETKMedicare ID - Type Unspecified
PAQ16074Medicare UPIN