1952332272 NPI number — DR. MADELEINE S BLANCHER MD

Table of content: DR. MADELEINE S BLANCHER MD (NPI 1952332272)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952332272 NPI number — DR. MADELEINE S BLANCHER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLANCHER
Provider First Name:
MADELEINE
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952332272
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 91899
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36691-1899
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-342-8900
Provider Business Mailing Address Fax Number:
251-342-2333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6321 PICCADILLY SQ DRIVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36609-5305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-342-8900
Provider Business Practice Location Address Fax Number:
251-342-2333
Provider Enumeration Date:
07/05/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  4513 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000810014 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51009547 . This is a "BC/BS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1210322 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 156512 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".