Provider Demographics
NPI:1356329478
Name:MARGUERITE M BLYTHE
Entity Type:Organization
Organization Name:MARGUERITE M BLYTHE
Other - Org Name:PRACTICAL PSYCHIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARGUERITE
Authorized Official - Middle Name:MARYANNA
Authorized Official - Last Name:BLYTHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-421-2900
Mailing Address - Street 1:4903 VINE ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45217-1252
Mailing Address - Country:US
Mailing Address - Phone:513-421-2900
Mailing Address - Fax:513-345-3045
Practice Address - Street 1:4903 VINE ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45217-1252
Practice Address - Country:US
Practice Address - Phone:513-421-2900
Practice Address - Fax:513-345-3045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350525702084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0671161Medicaid
OHMA9246121Medicare ID - Type Unspecified