Basic Information
| Provider Information | |||||||||
| NPI: | 1821357591 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLANCHARD | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | BRYANT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 WHITE OAK ST | ||||||||
| Address2: | |||||||||
| City: | ASHEBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272034710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366251360 | ||||||||
| FaxNumber: | 3366251889 | ||||||||
| Practice Location | |||||||||
| Address1: | 197 NC HIGHWAY 42 N STE B | ||||||||
| Address2: | |||||||||
| City: | ASHEBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272037968 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366252560 | ||||||||
| FaxNumber: | 3366253562 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2012 | ||||||||
| LastUpdateDate: | 01/29/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 208247 | LA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 2019-02186 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2019-02186 | 01 | NC | NC STATE LICENSE | OTHER |