1720379225 NPI number — MRS. ASHLEY SHERI BLACKLEDGE M.D.

Table of content: MRS. ASHLEY SHERI BLACKLEDGE M.D. (NPI 1720379225)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720379225 NPI number — MRS. ASHLEY SHERI BLACKLEDGE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLACKLEDGE
Provider First Name:
ASHLEY
Provider Middle Name:
SHERI
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CRUMP
Provider Other First Name:
ASHLEY
Provider Other Middle Name:
SHERI
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720379225
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9729 COUNTRY MEADOWS LN
Provider Second Line Business Mailing Address:
APT 1B
Provider Business Mailing Address City Name:
LAUREL
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20723-6305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-873-1932
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
960 FOREST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOVER
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19904-3470
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-735-1888
Provider Business Practice Location Address Fax Number:
302-735-1802
Provider Enumeration Date:
05/02/2011

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: 207Q00000X , with the licence number:  C1-0010651 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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