Healthcare Provider Details

I. General information

NPI: 1326238452
Provider Name (Legal Business Name): RON BLANKSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 05/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST BWH ; ROOM SH 5096
BOSTON MA
02115-6110
US

IV. Provider business mailing address

75 FRANCIS ST BWH ; ROOM SH 5096
BOSTON MA
02115-6110
US

V. Phone/Fax

Practice location:
  • Phone: 857-307-1989
  • Fax:
Mailing address:
  • Phone: 857-307-1989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number232346
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: