1235665308 NPI number — CHRISTOPHER BLACKSTOCK M.D., PH.D.

Table of content: LINDA LYNETTE VINSON (NPI 1386477065)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235665308 NPI number — CHRISTOPHER BLACKSTOCK M.D., PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLACKSTOCK
Provider First Name:
CHRISTOPHER
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D., PH.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235665308
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1514 JEFFERSON HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70121-2429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-842-4000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 OCHSNER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRETNA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70056-5255
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-595-8020
Provider Business Practice Location Address Fax Number:
504-391-8707
Provider Enumeration Date:
05/10/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X , with the licence number:  MT213385 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X , with the licence number: 333584 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MT213385 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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