Provider Demographics
NPI:1629445325
Name:BLACHE, TONYA (MD)
Entity Type:Individual
Prefix:DR
First Name:TONYA
Middle Name:
Last Name:BLACHE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TONYA
Other - Middle Name:
Other - Last Name:GOSHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1117 CHILMARK AVE
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-5334
Mailing Address - Country:US
Mailing Address - Phone:919-569-6708
Mailing Address - Fax:
Practice Address - Street 1:1117 CHILMARK AVE
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-5334
Practice Address - Country:US
Practice Address - Phone:919-569-6708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA350572083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine