Provider Demographics
NPI:1841227147
Name:BLANCHARD, PATRICIA (PA-C)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 BROADLANDS DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-3712
Mailing Address - Country:US
Mailing Address - Phone:919-850-0775
Mailing Address - Fax:
Practice Address - Street 1:3320 WAKE FOREST RD
Practice Address - Street 2:SUITE 200-A
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7300
Practice Address - Country:US
Practice Address - Phone:919-876-5864
Practice Address - Fax:919-876-7104
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103535363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP70923Medicare UPIN
NC2756738CMedicare PIN
NC2756738Medicare ID - Type Unspecified