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General NPI Number Information
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NPI Number | 1457353963
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Entity Type | Individual
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Provider Name | STEPHEN WARREN BLATCHLY M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/15/2005
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Last Update Date | 02/04/2019
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Provider Practice Location Address
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Address Line | 823 MICHIGAN ST BLDG B
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City | SIDNEY
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State | OH
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Zip | 45365-2685
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Country | US
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Telephone | 937-498-1335
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Fax | 937-498-1011
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Provider Business Mailing Address
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Address Line | 823 MICHIGAN ST BLDG B
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City | SIDNEY
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State | OH
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Zip | 45365-2685
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Country | US
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Telephone | 937-498-1335
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Fax | 937-498-1011
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35043788
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 35043788
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License Number State | OH
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