Healthcare Provider Details

I. General information

NPI: 1457365389
Provider Name (Legal Business Name): DENISE L BLOCKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 AFRICA RD
WESTERVILLE OH
43082-9808
US

IV. Provider business mailing address

655 AFRICA RD
WESTERVILLE OH
43082-9808
US

V. Phone/Fax

Practice location:
  • Phone: 614-865-3172
  • Fax: 614-865-2781
Mailing address:
  • Phone: 614-865-3172
  • Fax: 614-865-2781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35063691
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35063691
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: