Healthcare Provider Details

I. General information

NPI: 1306589874
Provider Name (Legal Business Name): DAVID VINCENT BLIHAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 BELMONT AVE
YOUNGSTOWN OH
44504-1006
US

IV. Provider business mailing address

1621 VIEW LN
GREEN BAY WI
54313-5302
US

V. Phone/Fax

Practice location:
  • Phone: 330-746-7211
  • Fax:
Mailing address:
  • Phone: 920-621-5296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number2084E0001X
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number57.254680
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: