Healthcare Provider Details

I. General information

NPI: 1225076474
Provider Name (Legal Business Name): RONALD JEFFREY BLANK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 09/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 NORTHAMPTON ST
EASTHAMPTON MA
01027-1051
US

IV. Provider business mailing address

PO BOX 60396
FLORENCE MA
01062-0396
US

V. Phone/Fax

Practice location:
  • Phone: 413-586-2440
  • Fax:
Mailing address:
  • Phone: 413-586-2440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number43035
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: