Provider Demographics
NPI:1083275697
Name:BLANCHARD, IANNA (MD)
Entity type:Individual
Prefix:
First Name:IANNA
Middle Name:
Last Name:BLANCHARD
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:ETSU DEPARTMENT OF PEDIATRICS
Mailing Address - Street 2:DOGWOOD AVE BUILDING 1 BOX 70578
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37614
Mailing Address - Country:US
Mailing Address - Phone:423-439-6763
Mailing Address - Fax:423-439-8066
Practice Address - Street 1:800 ROSE ST FL 1
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-6035
Practice Address - Country:US
Practice Address - Phone:859-562-1085
Practice Address - Fax:859-257-5152
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-25
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY565952080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty