Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Kelso Lynne-Borrell Blaze

Individual provider Physician Assistant · NPI 1255096707

Kelso Lynne-Borrell Blaze is a Physician Assistant in Philadelphia, Pennsylvania. Qualified in 2022, 4 years ago. Practices with Bobby Buka, MD, PC, a 143-clinician group and accepts Medicare assignment.

Years since qualifying
4
In the registry since
2021
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Practice location Address checks out

2530 N Howard St Unit 2
Philadelphia, PA 19133
Phone: (732) 744-4962
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1255096707
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedNovember 1, 2021
Last updated in NPPESNovember 1, 2021
Certification dateOctober 12, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Bobby Buka, M.D., P.C. — 143 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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