Provider Demographics
NPI:1235107970
Name:MAEROWITZ, BLAIR J (PA-C)
Entity type:Individual
Prefix:PROF
First Name:BLAIR
Middle Name:J
Last Name:MAEROWITZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:29B COTTAGE ST
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-1206
Mailing Address - Country:US
Mailing Address - Phone:508-754-3823
Mailing Address - Fax:508-753-0151
Practice Address - Street 1:29 COTTAGE STREET
Practice Address - Street 2:B (PIONEER VALLEY DERMATOLOGY)
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-1206
Practice Address - Country:US
Practice Address - Phone:413-406-3250
Practice Address - Fax:413-549-7402
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1521363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9700340Medicaid
MA290001521MA01OtherANTHEM
MA114411681OtherGROUP NPI
MAAP182501Medicare PIN
MA9700340Medicaid