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Licensee Information

Zachary Ian Blake - PA-C
0010-15439
Active
No
06/18/2025
12/22/2026

Active Supervisor

NameTypeStatusApprovedInactive
Datta, Amit Kumar, MD MD Active 02/23/2026

North Carolina Hospital Admitting Privileges

Location
None Reported

Out of State Active/Inactive Licenses

State
West Virginia

Out of Country Active/Inactive Licenses

Country
None Reported
Information loaded from this database is current as of 5/10/2026 1:00:36 PM
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