Basic Information
| Provider Information | |||||||||
| NPI: | 1710987979 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLAZEK-O'NEILL | ||||||||
| FirstName: | BETSY | ||||||||
| MiddleName: | W. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 S JACKSON AVE | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152023428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123598951 | ||||||||
| FaxNumber: | 4127347795 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 S JACKSON AVE | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152023428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123598951 | ||||||||
| FaxNumber: | 4127347795 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2005 | ||||||||
| LastUpdateDate: | 12/01/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | MD044471L | PA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 001686719 | 05 | PA | MEDICAID | 10923243 | 01 | CAQH | OTHER |