Provider Demographics
NPI:1780678599
Name:BLASS, LEONARD PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:PAUL
Last Name:BLASS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 N LINDEN CT
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-6038
Mailing Address - Country:US
Mailing Address - Phone:330-841-9609
Mailing Address - Fax:330-841-9569
Practice Address - Street 1:1350 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-6608
Practice Address - Country:US
Practice Address - Phone:330-841-9699
Practice Address - Fax:330-841-9569
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-5525-B207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0647705Medicaid
OHC03131Medicare UPIN