Provider Demographics
NPI:1770590226
Name:BLANDA, JOSEPH B (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:B
Last Name:BLANDA
Suffix:
Gender:M
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 1:2383 S MAIN ST
Mailing Address - Street 2:SUITE D106
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44319-1196
Mailing Address - Country:US
Mailing Address - Phone:330-785-9357
Mailing Address - Fax:330-785-9432
Practice Address - Street 1:2383 S MAIN ST
Practice Address - Street 2:SUITE D106
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44319-1190
Practice Address - Country:US
Practice Address - Phone:330-785-9356
Practice Address - Fax:330-785-9432
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35053763B207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341049560DOtherSUMMA CARE
OH000000139790OtherANTHEM
OH0862839Medicaid
OH60162OtherUNITED HEALTH CARE
OH0862839Medicaid
OH0699943Medicare PIN
OH1109320001Medicare NSC
OHE66816Medicare UPIN