MEDICARE: CARLOS BLANCO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	0101274737	VA
2	2084P0800X	Psychiatry Physician	EMC0002024	MI
3	2084P0800X	Psychiatry Physician	25MA11522700	NJ
4	2084P0800X	Psychiatry Physician	ME153012	FL
5	2084P0800X	Psychiatry Physician	MD20000103	DC
6	2084P0800X	Psychiatry Physician	D0080358	MD
7	2084P0800X	Psychiatry Physician	209066	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275654154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS BLANCO

Provider Business Mailing Address
First Line	:	1111 23RD ST NW APT 6A
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20037-3323
Country	:	US
Telephone Number	:	917-617-3245
Fax Number	:	202-301-1282

Provider Business Practice Location Address
First Line	:	25 W 81ST ST STE 1B
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-6023
Country	:	US
Telephone Number	:	917-617-3245
Fax Number	:	202-301-1282

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	06/23/2023

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Directions to “ CARLOS BLANCO ” Practice Location

Language	Start Address	Practice Location

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