Provider Demographics
NPI:1558453712
Name:DEBLASIO, DOMINICK J (MD)
Entity Type:Individual
Prefix:
First Name:DOMINICK
Middle Name:J
Last Name:DEBLASIO
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 1:3333 BURNET AVE., ML 5026
Mailing Address - Street 2:CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229
Mailing Address - Country:US
Mailing Address - Phone:513-636-7722
Mailing Address - Fax:513-636-3737
Practice Address - Street 1:3333 BURNET AVE., ML 5026
Practice Address - Street 2:CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229
Practice Address - Country:US
Practice Address - Phone:513-636-7722
Practice Address - Fax:513-636-3737
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-083777208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics