Basic Information
| Provider Information | |||||||||
| NPI: | 1295933109 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | BLENDEA | ||||||||
| FirstName: | MIHAELA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 736 CAMBRIDGE ST | ||||||||
| Address2: | CMP 5 | ||||||||
| City: | BRIGHTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021352907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177892464 | ||||||||
| FaxNumber: | 6175627932 | ||||||||
| Practice Location | |||||||||
| Address1: | 11 NEVINS ST. | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | BRIGHTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177796700 | ||||||||
| FaxNumber: | 6177796771 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2007 | ||||||||
| LastUpdateDate: | 12/13/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 231485 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RE0101X | 231485 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
No ID Information.