Provider Demographics
NPI:1730486309
Name:BLAGOVICH, AIMEE RENEE MAE (DO)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:RENEE MAE
Last Name:BLAGOVICH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:AIMEE
Other - Middle Name:RENEE MAE
Other - Last Name:WASHINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2000 EOFF ST
Mailing Address - Street 2:EMP OFFICE
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3823
Mailing Address - Country:US
Mailing Address - Phone:304-234-8111
Mailing Address - Fax:
Practice Address - Street 1:2000 EOFF ST
Practice Address - Street 2:EMP OFFICE
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3823
Practice Address - Country:US
Practice Address - Phone:304-234-8111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2529207P00000X
OH34-010430207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine