Provider Demographics
NPI:1053363283
Name:BLANDINO, DAVID A (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:BLANDINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6023 HARVARD SQUARE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3015
Mailing Address - Country:US
Mailing Address - Phone:412-361-8284
Mailing Address - Fax:412-361-8268
Practice Address - Street 1:6023 HARVARD SQUARE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3015
Practice Address - Country:US
Practice Address - Phone:412-361-8284
Practice Address - Fax:412-361-8268
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022199E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000927282Medicaid
PA039759Medicare ID - Type Unspecified
PA000927282Medicaid