Provider Demographics
NPI:1063772929
Name:BLANCHETTE, ELIZA DAVIS (MD)
Entity type:Individual
Prefix:
First Name:ELIZA
Middle Name:DAVIS
Last Name:BLANCHETTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZA
Other - Middle Name:KATHERINE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13123 E 16TH AVE # 328
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-7106
Mailing Address - Country:US
Mailing Address - Phone:720-777-7878
Mailing Address - Fax:720-777-7200
Practice Address - Street 1:13123 E 16TH AVE # 328
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7106
Practice Address - Country:US
Practice Address - Phone:720-777-7878
Practice Address - Fax:720-777-4592
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI62110-20208000000X, 2080N0001X
CODR.00626402080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine