Healthcare Provider Details

I. General information

NPI: 1588965271
Provider Name (Legal Business Name): JACALYN BLACKWELL-WHITE, M,D., PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2010
Last Update Date: 11/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3527 N ROLLING RD SUITE 1
BALTIMORE MD
21244-2223
US

IV. Provider business mailing address

3527 N ROLLING RD SUITE 1
BALTIMORE MD
21244-2223
US

V. Phone/Fax

Practice location:
  • Phone: 410-521-7337
  • Fax: 410-521-7377
Mailing address:
  • Phone: 410-521-7337
  • Fax: 410-521-7377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. CLIFTON FRANCIS WHITE
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 410-521-7337