Provider Demographics
NPI:1942276944
Name:DUNKLE-BLATTER, STEPHANIE E (MD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:E
Last Name:DUNKLE-BLATTER
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:PO BOX 7527
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-0727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:75 HOSPITAL DR STE 310
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2860
Practice Address - Country:US
Practice Address - Phone:740-594-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01066021A208600000X, 2086S0129X
KY40576208600000X
OH35.121953208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100020980Medicaid
KY37903705OtherMEDICAID LAB GROUP
KY4000501OtherMEDICARE LAB GROUP
KYASC1019OtherASC MEDICARE GROUP
KYCB5773OtherRR MEDICARE GROUP
KY36000818OtherASC MEDICAID GROUP
KYP00397697OtherRR MEDICARE PIN
PA101266510Medicaid
KY0092721Medicare PIN
KYASC1019OtherASC MEDICARE GROUP
PA101266510Medicaid