Provider Demographics
NPI:1366499279
Name:VERMILION, BLAIR D (MD)
Entity Type:Individual
Prefix:DR
First Name:BLAIR
Middle Name:D
Last Name:VERMILION
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 1:700 ACKERMAN RD
Mailing Address - Street 2:SUITE 570
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-8536
Mailing Address - Fax:614-293-8902
Practice Address - Street 1:4830 KNIGHTSBRIDGE BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-2300
Practice Address - Country:US
Practice Address - Phone:614-885-6856
Practice Address - Fax:614-885-4296
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350351492086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0498975Medicaid
E57697Medicare UPIN
OHVE0510057Medicare PIN