Provider Demographics
NPI:1427313113
Name:BLASI, MELINA ALICE (AUD)
Entity type:Individual
Prefix:
First Name:MELINA
Middle Name:ALICE
Last Name:BLASI
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:MELINA
Other - Middle Name:ALICE
Other - Last Name:ECOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:6565 N CHARLES ST
Mailing Address - Street 2:PPE 601
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6800
Mailing Address - Country:US
Mailing Address - Phone:410-821-5151
Mailing Address - Fax:410-823-8309
Practice Address - Street 1:6565 N CHARLES ST
Practice Address - Street 2:PPE 601
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-6800
Practice Address - Country:US
Practice Address - Phone:410-821-5151
Practice Address - Fax:410-823-8309
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01260231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH522Medicare PIN