Provider Demographics
NPI:1467958587
Name:O'CONNOR, BLAKE ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:BLAKE
Middle Name:ANTHONY
Last Name:O'CONNOR
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 1:3300 MERCY HEALTH BLVD STE 2010
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-1103
Mailing Address - Country:US
Mailing Address - Phone:513-961-4335
Mailing Address - Fax:513-872-5769
Practice Address - Street 1:3300 MERCY HEALTH BLVD STE 2010
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-1103
Practice Address - Country:US
Practice Address - Phone:513-961-4335
Practice Address - Fax:513-872-5769
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.149121208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program