Provider Demographics
NPI:1730125469
Name:BLAHD, WILLIAM HENRY JR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:HENRY
Last Name:BLAHD
Suffix:JR
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 1:423 E. 23RD ST
Mailing Address - Street 2:DEPT. OF VETERANS AFFAIRS
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001
Mailing Address - Country:US
Mailing Address - Phone:208-387-0119
Mailing Address - Fax:
Practice Address - Street 1:423 E. 23RD ST
Practice Address - Street 2:DEPT. OF VETERANS AFFAIRS
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001
Practice Address - Country:US
Practice Address - Phone:208-459-4641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-6410207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B95046Medicare UPIN
ID1145355Medicare ID - Type Unspecified