Provider Demographics
NPI:1922004399
Name:BLAIR, SCOTT C (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:C
Last Name:BLAIR
Suffix:
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 1:810 JASONWAY AVE
Mailing Address - Street 2:STE A
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-4359
Mailing Address - Country:US
Mailing Address - Phone:614-442-3130
Mailing Address - Fax:614-442-3145
Practice Address - Street 1:810 JASONWAY AVE
Practice Address - Street 2:STE A
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-4359
Practice Address - Country:US
Practice Address - Phone:614-442-3130
Practice Address - Fax:614-442-3145
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35063511207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000013765OtherANTHEM
OH0881336Medicaid
OH3600070OtherUHC
OH200635OtherNATIONWIDE
OH830002309OtherRAILROAD MEDICARE
OH830002309OtherRAILROAD MEDICARE
OHBL0782101Medicare ID - Type Unspecified