Provider Demographics
NPI:1942229158
Name:DAVID, BLANCA R (MD)
Entity type:Individual
Prefix:
First Name:BLANCA
Middle Name:R
Last Name:DAVID
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:765-298-5706
Mailing Address - Fax:765-298-4913
Practice Address - Street 1:1601 MEDICAL ARTS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-3459
Practice Address - Country:US
Practice Address - Phone:765-298-5700
Practice Address - Fax:765-298-4913
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2023-11-27
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Provider Licenses
StateLicense IDTaxonomies
IN01041183A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100352490Medicaid
IN000000313019OtherANTHEM
INM400024737Medicare PIN
INF44318Medicare UPIN
IN100352490Medicaid
IN213360AMedicare PIN