Provider Demographics
NPI:1437256468
Name:BLANCHARD, MELVIN S (MD)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:S
Last Name:BLANCHARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:CB 8121
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-5060
Mailing Address - Fax:314-362-6959
Practice Address - Street 1:4950 CHILDRENS PL
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1000
Practice Address - Country:US
Practice Address - Phone:314-362-5060
Practice Address - Fax:314-362-6959
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2019-07-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO105999207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205721616Medicaid
ILENROLLEDMedicaid
MOP00362594Medicare PIN
MO960770183Medicare PIN