Provider Demographics
NPI:1740282201
Name:BLACHLY, ELIZABETH A (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:A
Last Name:BLACHLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-0129
Mailing Address - Country:US
Mailing Address - Phone:317-468-6270
Mailing Address - Fax:317-468-6268
Practice Address - Street 1:7375 W US HIGHWAY 52
Practice Address - Street 2:
Practice Address - City:NEW PALESTINE
Practice Address - State:IN
Practice Address - Zip Code:46163-8950
Practice Address - Country:US
Practice Address - Phone:317-861-4171
Practice Address - Fax:317-861-5325
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01046880A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000112800OtherANTHEM PIN #
IN200311740OtherMEDICAID GROUP PIN #
IN5259508OtherAETNA PIN #
IN80156759OtherMEDICARE RAILROAD #
IN200156140Medicaid
ING58024Medicare UPIN
IN200156140Medicaid