Healthcare Provider Details

I. General information

NPI: 1821357591
Provider Name (Legal Business Name): MATTHEW BRYANT BLANCHARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2012
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 NC HIGHWAY 42 N STE B
ASHEBORO NC
27203-7968
US

IV. Provider business mailing address

550 WHITE OAK ST
ASHEBORO NC
27203-4710
US

V. Phone/Fax

Practice location:
  • Phone: 336-625-2560
  • Fax: 336-625-3562
Mailing address:
  • Phone: 336-625-1360
  • Fax: 336-625-1889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number208247
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2019-02186
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: