Provider Demographics
NPI:1306842042
Name:BLADES, MARY D (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:D
Last Name:BLADES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5885 HARRISON AVE
Mailing Address - Street 2:SUITE 3500
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45248-1651
Mailing Address - Country:US
Mailing Address - Phone:513-922-9960
Mailing Address - Fax:513-347-2347
Practice Address - Street 1:5885 HARRISON AVE
Practice Address - Street 2:SUITE 3500
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-1651
Practice Address - Country:US
Practice Address - Phone:513-922-9960
Practice Address - Fax:513-347-2347
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35067523207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH030497Medicaid
OHBL0804413Medicare PIN
G28031Medicare UPIN