Basic Information
| Provider Information | |||||||||
| NPI: | 1659434561 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLAZEK | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | V | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 SUMNER RD | ||||||||
| Address2: | LAFARGE JESUIT COMMUNITY | ||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021383015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2022763080 | ||||||||
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| Practice Location | |||||||||
| Address1: | 780 ALBANY ST | ||||||||
| Address2: | BOSTON HEALTH CARE FOR THE HOMELESS PROGRAM | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021182524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8576541000 | ||||||||
| FaxNumber: | 8576541100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2006 | ||||||||
| LastUpdateDate: | 12/17/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 242173 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.