MEDICARE: MARGUERITE M BLYTHE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0805X	Geriatric Psychiatry Physician	35052570	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356329478
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARGUERITE M BLYTHE

Provider Business Mailing Address
First Line	:	4903 VINE ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45217-1252
Country	:	US
Telephone Number	:	513-421-2900
Fax Number	:	513-345-3045

Provider Business Practice Location Address
First Line	:	4903 VINE ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45217-1252
Country	:	US
Telephone Number	:	513-421-2900
Fax Number	:	513-345-3045

Authorized Official
Title or Position	:	MD OWNER
Name	:	MARGUERITE MARYANNA BLYTHE
Credential	:	MD
Telephone Number	:	513-421-2900

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	05/04/2011

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