Provider Demographics
NPI:1629114665
Name:BLANK, CHRISTOPHER WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:WILLIAM
Last Name:BLANK
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 1:421 S CAMPUS AVE
Mailing Address - Street 2:195 HEALTH SERVICES CENTER
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056-2400
Mailing Address - Country:US
Mailing Address - Phone:513-529-4634
Mailing Address - Fax:513-529-2975
Practice Address - Street 1:421 S CAMPUS AVE
Practice Address - Street 2:195 HEALTH SERVICES CENTER
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-2400
Practice Address - Country:US
Practice Address - Phone:513-529-4634
Practice Address - Fax:513-529-2975
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-70032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000323345OtherANTHEM
OH2124310Medicaid
OH2124310Medicaid