Healthcare Provider Details

I. General information

NPI: 1699714774
Provider Name (Legal Business Name): DANIEL JOE BLOCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DANIEL J BLOCH MD

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 W LONG ST
COLUMBUS OH
43215-2815
US

IV. Provider business mailing address

16 W LONG ST
COLUMBUS OH
43215-2815
US

V. Phone/Fax

Practice location:
  • Phone: 614-225-0990
  • Fax:
Mailing address:
  • Phone: 614-225-0990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.069738
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number35069738
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number036.14811
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number35.069738
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: