=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356367346
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VIRGINIA B BLATCHLEY PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2006
-----------------------------------------------------
Last Update Date | 12/01/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 28421 PINEHURST CIR
-----------------------------------------------------
City | EASTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21601-8315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-310-4721
-----------------------------------------------------
Fax | 410-819-0524
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2043
-----------------------------------------------------
City | EASTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21601-8940
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-822-3188
-----------------------------------------------------
Fax | 410-820-4571
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 895
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------