DR. DIANE R BLAKE (NPI# 1316921182) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316921182 |
| Entity Type | Individual |
| Full Name | DR. DIANE R BLAKE |
| Other Name | DR. DIANE R BLAKE-JOHNSON |
| Credential | M.D. |
| Practice Address |
55 Lake Ave N Department of Adolescent Medicine Worcester MA 01655-0002 |
| Mailing Address |
Po Box 62 Turnpike Station Shrewsbury MA 01545-0062 |
| Practice Telephone | 5088565624 |
| Mailing Telephone | 5083348815 |
| Mailing Fax Number | 5083345374 |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2011-09-12 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080A0000X |
Pediatrics Specialization: Adolescent Medicine |
154470 | MA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MA | 3169863 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144581976 | Diane M Blake | Specialist | 1 Comus Rd, Rocky Point, NY 11778-9541 | 2012-06-07 |
| 1437502903 | Diane Blake | Social Worker | 80 Eureka Sq, Suite 151, Pacifica, CA 94044-2654 | 2016-07-19 |
| Street Address |
55 LAKE AVE N DEPARTMENT OF ADOLESCENT MEDICINE |
| City | WORCESTER |
| State | MA |
| Zip Code | 01655-0002 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477556587 | James E Liebmann | Internal Medicine | 55 Lake Ave N, Hematology/oncology, Worcester, MA 01655-0002 | 2005-05-23 |
| 1518568732 | Justin Bullard | Psychologist | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-11-04 |
| 1346849825 | Meghan Moore | Nurse Practitioner | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-10-26 |
| 1174122899 | Jessica Goncalves Ferreira | Nurse Practitioner | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-10-23 |
| 1235746686 | Desiree Mytych | Student in an Organized Health Care Education/Training Program | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-09-29 |
| 1659986248 | Rebecca Lynn Harris | Student in an Organized Health Care Education/Training Program | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-09-10 |
| 1639781487 | Gabriella Kathleen Holland | Student in an Organized Health Care Education/Training Program | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-08-21 |
| 1730791898 | Kerry Anne Benedict | Speech-Language Pathologist | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-08-20 |
| 1902418999 | Natasha R. Turner | Genetic Counselor, MS | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-08-20 |
| 1144830712 | Abbey Corsini | Nurse Practitioner | 55 Lake Ave N, Worcester, MA 01655-0002 | 2020-08-07 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205489713 | Darryl Sweeper Jr. | Student in an Organized Health Care Education/Training Program | 55 Lake Avenue North, Psychiatry, Umass Memorial Medical Center, Worcester, MA 01655 | 2019-07-23 |
| 1225690530 | Ryan Zenevitch | Student in an Organized Health Care Education/Training Program | 55 Lake Avenue North, Family Medicine, Umass Memorial Medical Center, Worcester, MA 01655 | 2019-07-08 |
| 1932688454 | Victoria Sayeg | Student in an Organized Health Care Education/Training Program | 55 Lake Avenue North, Pediatrics, Worcester, MA 01655 | 2018-08-07 |
| 1114425675 | Judith Dio Wentzell | Social Worker | Umassmemorial Medical Center, 55 Lake Ave North, Dept of Care Coordination, Worcester, MA 01655 | 2018-01-30 |
| 1861927386 | Muhammad Waqas Khan | Student in an Organized Health Care Education/Training Program | University of Massachusetts 55 North Lake Ave, Neurology, Worcester, MA 01655 | 2017-04-21 |
| 1861806192 | Qaiser Shamshir Khan | Psychiatry & Neurology | 55 Lake Ave N # S7-831, Worcester, MA 01655 | 2014-06-14 |
| 1073858981 | Heidi Glover | Nurse Practitioner | 55 Lake Ave North Dept. of Pedi-adolescent, Ummc University Campus, Worcester, MA 01655 | 2012-12-04 |
| 1972867992 | Anna Bjornsdottir | Psychiatry & Neurology | 55 Lake Av N, Worcester, MA 01655 | 2012-06-25 |
| 1245567676 | Steven Edward Mckinley | Nurse Practitioner | 55 Lake Ave. North, Umass Memorial Medical Center University Campus, Worcester, MA 01655 | 2009-11-05 |
| 1851582951 | Robin I Davidson | Neurological Surgery | 55 Lake Ave, North, Ummhc-univ Campus, Worcester, MA 01655 | 2007-08-05 |
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| Taxonomy Code | 2080A0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Adolescent Medicine |
| A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770794596 | Dr.babu Pediatrics P.C. | Pediatrics | 10 Winthrop St, Suite#319, Worcester, MA 01604-4435 | 2007-05-24 |
| 1366576522 | Harding Pediatrics, LLP | Pediatrics | 45 Oak Ave, Worcester, MA 01605-0000 | 2007-03-16 |
| 1770665952 | Joyee Nobis | Pediatrics | 45 Oak Ave, Worcester, MA 01605-2730 | 2006-10-19 |
| 1720160062 | John William Harding | Pediatrics | 45 Oak Ave, Worcester, MA 01605-2730 | 2006-10-19 |
| 1679655831 | Emma Hughes | Pediatrics | 45 Oak Ave, Worcester, MA 01605-2730 | 2006-10-19 |
| 1821088139 | Marianne E Felice | Pediatrics | 55 Lake Ave N, Department of Pediatric Adolescent Medicine, Worcester, MA 01655-0002 | 2005-10-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033359898 | Bharati Reejhsinghani Md | Pediatrics | 754 Chestnut St, Springfield, MA 01107-1614 | 2009-03-05 |
| 1437301900 | Vaibhav Goyal | Pediatrics | 874 Purchase Street, Greater New Bedford Community Health, New Bedford, MA 02740 | 2008-10-16 |
| 1649455973 | Robert J. Giordano Md PC | Pediatrics | 100 South St Ste 205, Southbridge, MA 01550-4051 | 2008-01-06 |
| 1407979560 | Bharati Nandlal Reejhsinghani | Pediatrics | 754 Chestnut Street, Springfield, MA 01107 | 2007-04-06 |
| 1609903582 | Harris C Faigel | Pediatrics | 55 Kensington Cir, Chestnut Hill, MA 02467-2675 | 2007-02-27 |
| 1871667303 | Brian J. Dempsey Md | Pediatrics | 758 East St, Pittsfield, MA 01201-5326 | 2006-11-17 |
| 1295757268 | Mark Vonnegut | Pediatrics | 21 Totman Street #2, Quincy, MA 02169 | 2006-07-25 |
| 1356390215 | Richard John Kerbel | Pediatrics | 548 Mount Auburn St, Watertown, MA 02472-4122 | 2006-05-09 |
| 1487602884 | Paula K Braverman | Pediatrics | 50 Wason Avenue, Springfield, MA 01107-1274 | 2006-05-05 |
| 1619930559 | Marianne Sarah Koenig | Pediatrics | 449 Route 130, Sandwich, MA 02563-2339 | 2006-04-11 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.