Healthcare Provider Details

I. General information

NPI: 1740282201
Provider Name (Legal Business Name): ELIZABETH A BLACHLY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7375 W US HIGHWAY 52
NEW PALESTINE IN
46163-8950
US

IV. Provider business mailing address

PO BOX 129
GREENFIELD IN
46140-0129
US

V. Phone/Fax

Practice location:
  • Phone: 317-861-4171
  • Fax: 317-861-5325
Mailing address:
  • Phone: 317-468-6270
  • Fax: 317-468-6268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01046880A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: