Healthcare Provider Details

I. General information

NPI: 1194475814
Provider Name (Legal Business Name): KRISTIN TROUTMAN BLACKLEDGE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. KRISTIN ELIZABETH TROUTMAN

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 ALLEN RD
BASKING RIDGE NJ
07920-2976
US

IV. Provider business mailing address

140 ALLEN RD
BASKING RIDGE NJ
07920-2976
US

V. Phone/Fax

Practice location:
  • Phone: 877-749-3418
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number25MA13023900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: