Provider Demographics
NPI:1770133035
Name:BLAIS, ANDREW VAN
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:VAN
Last Name:BLAIS
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 1:102 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-3275
Mailing Address - Country:US
Mailing Address - Phone:413-262-4363
Mailing Address - Fax:
Practice Address - Street 1:102 MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-3275
Practice Address - Country:US
Practice Address - Phone:413-262-4363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist