Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | MD069536L | PA |
NPI | 1043284722 |
---|---|
Provider Name | Sherri E Blackstone |
First Address | Philadelphia, PA 19178-9967 |
Second Address | Lansdale, PA 19446-1004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2006 |
Last Update Date | 15/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2147675000 | DBC (01) | PA |
7491423 | AETNA (01) | PA |
H44074 | (02) |