Provider Demographics
NPI:1821377250
Name:BLAHOVEC, LYNDANNE
Entity Type:Individual
Prefix:
First Name:LYNDANNE
Middle Name:
Last Name:BLAHOVEC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 S 8TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-2776
Mailing Address - Country:US
Mailing Address - Phone:724-427-2765
Mailing Address - Fax:
Practice Address - Street 1:15 S 8TH ST STE 201
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-2776
Practice Address - Country:US
Practice Address - Phone:724-427-2765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ5355208M00000X, 207R00000X
PAOS017182207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX348522901Medicaid
TX348522901Medicaid