Healthcare Provider Details

I. General information

NPI: 1205800521
Provider Name (Legal Business Name): DEBORAH L BLACKER MD SCD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST 149 2691 MASSACHUSETTS GENERAL HOSPITAL
BOSTON MA
02114
US

IV. Provider business mailing address

PO BOX 9142 MASS GENERAL PHYSICIAN ORGANIZATION
CHARLESTOWN MA
02129-9142
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-5571
  • Fax: 617-726-5760
Mailing address:
  • Phone: 617-724-0287
  • Fax: 617-726-2894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number55900
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number55900
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: