Provider Demographics
NPI:1952374977
Name:BLANCHARD VALLEY PATHOLOGY & LAB INC
Entity Type:Organization
Organization Name:BLANCHARD VALLEY PATHOLOGY & LAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DARJA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRAPROTNIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-423-5322
Mailing Address - Street 1:3455 MILL RUN DR
Mailing Address - Street 2:SUITE 450
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-9078
Mailing Address - Country:US
Mailing Address - Phone:877-462-6017
Mailing Address - Fax:614-771-2248
Practice Address - Street 1:1900 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-1214
Practice Address - Country:US
Practice Address - Phone:419-423-5322
Practice Address - Fax:419-423-5125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-09
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000026629OtherANTHEM
OH0513180Medicaid
OH=========00OtherAWC
OH9917353Medicare ID - Type Unspecified