1457300667 NPI number — ROBERT H BLINN PH.D.

Table of content: ROBERT H BLINN PH.D. (NPI 1457300667)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457300667 NPI number — ROBERT H BLINN PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLINN
Provider First Name:
ROBERT
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1457300667
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
920 SHENANDOAH VILLAGE DR STE 124
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAYNESBORO
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22980
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-932-7800
Provider Business Mailing Address Fax Number:
540-932-7191

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
920 SHENANDOAH VILLAGE DR STE 124
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAYNESBORO
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22980
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-932-7800
Provider Business Practice Location Address Fax Number:
540-932-7191
Provider Enumeration Date:
05/08/2006

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: 103TC0700X , with the licence number:  0810001095 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2179643 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 083086 . This is a "SENTARA MENTAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 173898 . This is a "COMPSYCH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7700261 . This is a "VIRGINIA PREMIER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 061341 . This is a "ANTHEM BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 140695 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7700261 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 132963 . This is a "MHN" identifier . This identifiers is of the category "OTHER".




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