Healthcare Provider Details

I. General information

NPI: 1467958587
Provider Name (Legal Business Name): BLAKE ANTHONY O'CONNOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 MERCY HEALTH BLVD STE 2010
CINCINNATI OH
45211-1103
US

IV. Provider business mailing address

3300 MERCY HEALTH BLVD STE 2010
CINCINNATI OH
45211-1103
US

V. Phone/Fax

Practice location:
  • Phone: 513-961-4335
  • Fax: 513-872-5769
Mailing address:
  • Phone: 513-961-4335
  • Fax: 513-872-5769

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 State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35.149121
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: