Provider Demographics
NPI:1720242118
Name:RICHARD BLANCHAR MD PA
Entity Type:Organization
Organization Name:RICHARD BLANCHAR MD PA
Other - Org Name:BAYVIEW GENERAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MASTROSIMONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-776-6992
Mailing Address - Street 1:4401 W TRADEWINDS AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:LAUDERDALE BY THE SEA
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4463
Mailing Address - Country:US
Mailing Address - Phone:954-776-6992
Mailing Address - Fax:954-776-6969
Practice Address - Street 1:4401 W TRADEWINDS AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:LAUDERDALE BY THE SEA
Practice Address - State:FL
Practice Address - Zip Code:33308-4463
Practice Address - Country:US
Practice Address - Phone:954-776-6992
Practice Address - Fax:954-776-6969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0042534207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45031Medicare PIN