MEDICARE: ROBERT EUGENE BLACKBURN M.D.

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	207Q00000X	Family Medicine Physician	169882	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MD130D	OTHER	NY	PREFERRED CARE
2	5520487	OTHER	NY	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	000912964001	OTHER	NY	HEALTHNOW
5	CFP1698828	OTHER	NY	WORKERS COMPENSATION
6	6948	OTHER	NY	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1457318198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT EUGENE BLACKBURN M.D.

Provider Business Mailing Address
First Line	:	279 EAST AVE
Second Line	:	HILTON HEALTH CARE, P.C.
City	:	HILTON
State	:	NY
Zip	:	14468-1333
Country	:	US
Telephone Number	:	585-392-9100
Fax Number	:	585-392-4020

Provider Business Practice Location Address
First Line	:	279 EAST AVE
Second Line	:	HILTON HEALTH CARE, P.C.
City	:	HILTON
State	:	NY
Zip	:	14468-1333
Country	:	US
Telephone Number	:	585-392-9100
Fax Number	:	585-392-4020

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

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	11/13/2007

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