Healthcare Provider Details

I. General information

NPI: 1922004399
Provider Name (Legal Business Name): SCOTT C BLAIR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 JASONWAY AVE STE A
COLUMBUS OH
43214-4359
US

IV. Provider business mailing address

810 JASONWAY AVE STE A
COLUMBUS OH
43214-4359
US

V. Phone/Fax

Practice location:
  • Phone: 614-442-3130
  • Fax: 614-442-3145
Mailing address:
  • Phone: 614-442-3130
  • Fax: 614-442-3145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number35063511
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: