Healthcare Provider Details

I. General information

NPI: 1689606295
Provider Name (Legal Business Name): SARAH ELIZABETH BLAKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 04/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 OLENTANGY RIVER RD BLDG 480
COLUMBUS OH
43214-3437
US

IV. Provider business mailing address

3600 OLENTANGY RIVER RD STE 480
COLUMBUS OH
43214-3485
US

V. Phone/Fax

Practice location:
  • Phone: 614-442-0700
  • Fax:
Mailing address:
  • Phone: 614-442-0700
  • Fax: 614-442-0701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number35082586B
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: