Healthcare Provider Details

I. General information

NPI: 1508975632
Provider Name (Legal Business Name): CAROL L BLAND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2458 NEW MARKET BANTA RD
WEST ALEXANDRIA OH
45381-9708
US

IV. Provider business mailing address

2458 NEW MARKET BANTA RD
WEST ALEXANDRIA OH
45381-9708
US

V. Phone/Fax

Practice location:
  • Phone: 937-371-7490
  • Fax: 937-632-2606
Mailing address:
  • Phone: 937-371-7490
  • Fax: 937-632-2606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35073056B
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: