MEDICARE: MARY D BLADES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	35067523	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306842042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY D BLADES MD

Provider Business Mailing Address
First Line	:	5885 HARRISON AVE
Second Line	:	SUITE 3500
City	:	CINCINNATI
State	:	OH
Zip	:	45248-1651
Country	:	US
Telephone Number	:	513-922-9960
Fax Number	:	513-347-2347

Provider Business Practice Location Address
First Line	:	5885 HARRISON AVE
Second Line	:	SUITE 3500
City	:	CINCINNATI
State	:	OH
Zip	:	45248-1651
Country	:	US
Telephone Number	:	513-922-9960
Fax Number	:	513-347-2347

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	11/27/2023

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