Provider Demographics
| NPI: | 1669479044 |
|---|---|
| Name: | BLASKO, GREGORY (DPM) |
| Entity Type: | Individual |
| Prefix: | |
| First Name: | GREGORY |
| Middle Name: | |
| Last Name: | BLASKO |
| Suffix: | |
| Gender: | M |
| Credentials: | DPM |
| Other - Prefix: | |
| Other - First Name: | |
| Other - Middle Name: | |
| Other - Last Name: | |
| Other - Suffix: | |
| Other - Last Name Type: | |
| Other - Credentials: | |
| Mailing Address - Street 1: | PO BOX 378 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | SANDUSKY |
| Mailing Address - State: | OH |
| Mailing Address - Zip Code: | 44871-0378 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 419-626-6161 |
| Mailing Address - Fax: | 419-502-3511 |
| Practice Address - Street 1: | 3262 CENTER RD |
| Practice Address - Street 2: | |
| Practice Address - City: | POLAND |
| Practice Address - State: | OH |
| Practice Address - Zip Code: | 44514-2201 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 330-707-1220 |
| Practice Address - Fax: | 330-707-1066 |
| Is Sole Proprietor?: | No |
| Enumeration Date: | 2005-06-30 |
| Last Update Date: | 2019-02-21 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| OH | 36-00-2905 | 213E00000X |
| PA | SC-00-4402 | 213E00000X |
| WV | 330 | 213E00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| OH | 2052004 | Medicaid | |
| 0865803 | Medicare ID - Type Unspecified | ||
| 0865807 | Medicare ID - Type Unspecified | ||
| 0839566 | Medicare ID - Type Unspecified | ||
| 0865801 | Medicare ID - Type Unspecified | ||
| 0865802 | Medicare ID - Type Unspecified | ||
| 0865805 | Medicare ID - Type Unspecified | ||
| 4060823 | Medicare ID - Type Unspecified | ||
| OH | 2052004 | Medicaid | |
| 0839561 | Medicare ID - Type Unspecified | ||
| 0865808 | Medicare ID - Type Unspecified | ||
| 0885806 | Medicare ID - Type Unspecified | ||
| 4060822 | Medicare ID - Type Unspecified | ||
| 0839562 | Medicare ID - Type Unspecified | ||
| 0865804 | Medicare ID - Type Unspecified | ||
| 4060825 | Medicare ID - Type Unspecified | ||
| 0865809 | Medicare ID - Type Unspecified | ||
| 4060824 | Medicare ID - Type Unspecified | ||
| 4060821 | Medicare ID - Type Unspecified |
