Provider Demographics
NPI:1619666187
Name:BLAKE-SMITH, HENRY Q
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:Q
Last Name:BLAKE-SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 VILLAGE DR UNIT 1227
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-2088
Mailing Address - Country:US
Mailing Address - Phone:610-800-1789
Mailing Address - Fax:
Practice Address - Street 1:350 VILLAGE DR UNIT 1227
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-2088
Practice Address - Country:US
Practice Address - Phone:610-800-1789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies