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General NPI Number Information
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NPI Number | 1417661885
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Entity Type | Individual
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Provider Name | MATTHEW BLAIR PA-S
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Gender | Male
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Dates
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Enumeration Date | 01/10/2023
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 400 MATTHEW ST STE 302
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City | MARIETTA
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State | OH
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Zip | 45750-1656
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Country | US
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Telephone | 740-568-5207
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Fax | 740-434-0578
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Provider Business Mailing Address
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Address Line | 5160 W 86TH PL
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City | CROWN POINT
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State | IN
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Zip | 46307-1608
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Country | US
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Telephone | 219-213-5668
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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