| Provider / Organization | NPI | Date Certified |
|---|---|---|
| MICHAEL SCOTT BLAU | 1093789414 | 2024-11-08 |
Michael Scott Blau PA [M] graduated in 1995 and primarily specializes in Physician Assistant.
Michael Scott Blau is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1093789414. Registration indicates Michael Scott Blau is a provider of access to adult/geriatric primary care providers services with a specialization in Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant Access to Pediatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (Physician Assistant, ) (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (All Other Specialties & Provider Types, ) (Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers)
| PECOS ID | 3779544259 |
| Registration | PART-B:Y DME:Y HHA:Y PMD:Y |
| Entity Type | Individual |
| Provider Name | Michael Scott Blau PA-C |
| Practice Office Address | 190 KIMEL PARK DR STE 140 WINSTON SALEM, NC US |
| Practice Office Telephone | 3362772225 |
| Practice Office Fax | 3362772231 |
| Mailing Address | PO BOX 60447 CHARLOTTE, NC 282600447 US |
| Business Telephone | 3362772225 |
| Business Fax | 3362772231 |
| Code | Practice | License No State |
|---|---|---|
| 363A00000X PRIMARY | Access to Adult/Geriatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Physician AssistantAccess to Pediatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Physician Assistant Physician Assistant Physician Assistants & Advanced Practice Nursing Providers Physician Assistant All Other Specialties & Provider Types Physician Assistant Physician Assistants & Advanced Practice Nursing Providers | 103449
NC |
| 8102570 | MEDICAID | NC |