Provider Demographics
NPI:1134128184
Name:BLOSE, R DENNIS (MD)
Entity Type:Individual
Prefix:
First Name:R
Middle Name:DENNIS
Last Name:BLOSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 MOUNT CARMEL MALL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43222-1553
Mailing Address - Country:US
Mailing Address - Phone:614-434-2400
Mailing Address - Fax:614-434-2499
Practice Address - Street 1:750 MOUNT CARMEL MALL
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1553
Practice Address - Country:US
Practice Address - Phone:614-434-2400
Practice Address - Fax:614-434-2499
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35030950207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0171602Medicaid
OHBL0368413Medicare ID - Type Unspecified6075 E BROAD STREET
OH0171602Medicaid
OHBL0368412Medicare ID - Type Unspecified750 MT CARMEL MALL