Provider Demographics
NPI:1730121237
Name:SAVANI-BLACKHAM, DORA V (MD)
Entity Type:Individual
Prefix:DR
First Name:DORA
Middle Name:V
Last Name:SAVANI-BLACKHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DORA
Other - Middle Name:V
Other - Last Name:SAVANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:20 MEDICAL VILLAGE DR
Mailing Address - Street 2:SUITE 355
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-5401
Mailing Address - Country:US
Mailing Address - Phone:859-344-1512
Mailing Address - Fax:859-331-3698
Practice Address - Street 1:20 MEDICAL VILLAGE DR
Practice Address - Street 2:SUITE 355
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-5401
Practice Address - Country:US
Practice Address - Phone:859-344-1512
Practice Address - Fax:859-331-3698
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30946207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64309461Medicaid
KY64309461Medicaid
KY328804Medicare PIN