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General NPI Number Information
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NPI Number | 1689992760
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Entity Type | Individual
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Provider Name | GREGORY MICHAEL BLANTON MD
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Gender | Male
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Dates
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Enumeration Date | 05/13/2010
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Last Update Date | 01/09/2024
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Provider Practice Location Address
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Address Line | 5255 LOUGHBORO RD NW BLDG B
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City | WASHINGTON
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State | DC
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Zip | 20016-2633
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Country | US
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Telephone | 202-537-4080
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Fax | 202-537-4588
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Provider Business Mailing Address
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Address Line | 6201 GREENLEIGH AVE # 655
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City | MIDDLE RIVER
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State | MD
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Zip | 21220-2004
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Country | US
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Telephone | 410-933-2704
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD045667
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License Number State | DC
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