Provider Demographics
NPI:1669479044
Name:BLASKO, GREGORY (DPM)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:BLASKO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44871-0378
Mailing Address - Country:US
Mailing Address - Phone:419-626-6161
Mailing Address - Fax:419-502-3511
Practice Address - Street 1:3262 CENTER RD
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-2201
Practice Address - Country:US
Practice Address - Phone:330-707-1220
Practice Address - Fax:330-707-1066
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-2905213E00000X
PASC-00-4402213E00000X
WV330213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2052004Medicaid
0865803Medicare ID - Type Unspecified
0865807Medicare ID - Type Unspecified
0839566Medicare ID - Type Unspecified
0865801Medicare ID - Type Unspecified
0865802Medicare ID - Type Unspecified
0865805Medicare ID - Type Unspecified
4060823Medicare ID - Type Unspecified
OH2052004Medicaid
0839561Medicare ID - Type Unspecified
0865808Medicare ID - Type Unspecified
0885806Medicare ID - Type Unspecified
4060822Medicare ID - Type Unspecified
0839562Medicare ID - Type Unspecified
0865804Medicare ID - Type Unspecified
4060825Medicare ID - Type Unspecified
0865809Medicare ID - Type Unspecified
4060824Medicare ID - Type Unspecified
4060821Medicare ID - Type Unspecified