Provider Demographics
NPI:1508975632
Name:BLAND, CAROL L (MD)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:L
Last Name:BLAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2458 NEW MARKET BANTA RD
Mailing Address - Street 2:
Mailing Address - City:WEST ALEXANDRIA
Mailing Address - State:OH
Mailing Address - Zip Code:45381-9708
Mailing Address - Country:US
Mailing Address - Phone:937-371-7490
Mailing Address - Fax:937-632-2606
Practice Address - Street 1:2458 NEW MARKET BANTA RD
Practice Address - Street 2:
Practice Address - City:WEST ALEXANDRIA
Practice Address - State:OH
Practice Address - Zip Code:45381-9708
Practice Address - Country:US
Practice Address - Phone:937-371-7490
Practice Address - Fax:937-632-2606
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073056B207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2061174Medicaid
OH2061174Medicaid
OHG77318Medicare UPIN
OH0854902Medicare ID - Type UnspecifiedMEDICARE