NPI 1316921182 · live from the CMS NPI Registry
Diane R Blake, M.D.
Pediatrics, Adolescent Medicine in Worcester, MA. National Provider Identifier 1316921182, active.
NPI record
| NPI | 1316921182 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Pediatrics, Adolescent Medicine 2080A0000X |
| Practice location | 55 Lake Ave N, Department Of Adolescent Medicine, Worcester, MA 01655 |
| Practice phone | 508-856-5624 |
| Mailing address | Po Box 62, Turnpike Station, Shrewsbury, MA 01545 |
| Enumerated | December 5, 2005 |
| Last updated | July 14, 2026 |
| Sole proprietor | No |
| Other names | Diane Blake-Johnson |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Pediatrics, Adolescent Medicine primary | 2080A0000X | 154470 (MA) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.