Provider Demographics
NPI:1508975632
Name:BLAND, CAROL L (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:L
Last Name:BLAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45338-9503
Mailing Address - Country:US
Mailing Address - Phone:937-962-2618
Mailing Address - Fax:937-962-4971
Practice Address - Street 1:500 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:OH
Practice Address - Zip Code:45338-9503
Practice Address - Country:US
Practice Address - Phone:937-962-2618
Practice Address - Fax:937-962-4971
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073056B207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2061174Medicaid
OH2061174Medicaid
OHG77318Medicare UPIN
OH0854902Medicare ID - Type UnspecifiedMEDICARE