Individual
DR. JILL MARIE BLANDFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
2095 HENRY TECKLENBURG DR, CHARLESTON, SC 29414-5733
(843) 402-5035
(843) 402-5036
Mailing address
PO BOX 751649, CHARLOTTE, NC 28275-1649
(843) 789-1620
(843) 724-2440
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
03684
KY
2084N0400X
Neurology Physician
03684
KY
2084N0400X
Neurology Physician
Primary
1270
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001036470
ANTHEM - NNS
KY
01
—
170948
SIHO - NNS
KY
05
—
201392140
—
IN
01
—
50114236
PASSPORT - NNS
KY
05
—
7100321110
—
KY
Enumeration date
06/29/2009
Last updated
07/11/2022
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