Provider Demographics
NPI:1265733745
Name:BLAIR, DAVID J (CRNA)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:BLAIR
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:# L-3401
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43260-3401
Mailing Address - Country:US
Mailing Address - Phone:740-615-1349
Mailing Address - Fax:740-615-1344
Practice Address - Street 1:561 W CENTRAL AVE STE CBO
Practice Address - Street 2:ATTN: HEATHER HAINEY
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1410
Practice Address - Country:US
Practice Address - Phone:740-615-1349
Practice Address - Fax:740-615-1344
Is Sole Proprietor?:No
Enumeration Date:2010-11-15
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH363992163WC0200X
OHCOA.12043-NA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3103055Medicaid
OH3103055Medicaid