Provider Demographics
NPI:1972580942
Name:BLAHA, RENE V (MD)
Entity type:Individual
Prefix:DR
First Name:RENE
Middle Name:V
Last Name:BLAHA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:5031 FOREST DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-7088
Mailing Address - Country:US
Mailing Address - Phone:614-245-8582
Mailing Address - Fax:614-245-8531
Practice Address - Street 1:5031 FOREST DR
Practice Address - Street 2:SUITE B
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-7088
Practice Address - Country:US
Practice Address - Phone:614-245-8582
Practice Address - Fax:614-245-8531
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2011-05-03
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Provider Licenses
StateLicense IDTaxonomies
OH35043899B207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0466323Medicare ID - Type Unspecified
C01691Medicare UPIN