Provider Demographics
NPI:1124254586
Name:BLACKSTEN, CHERI A (MD)
Entity type:Individual
Prefix:
First Name:CHERI
Middle Name:A
Last Name:BLACKSTEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10777
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87184-0777
Mailing Address - Country:US
Mailing Address - Phone:505-554-2409
Mailing Address - Fax:505-554-2876
Practice Address - Street 1:8202 LOUISIANA BLVD NE
Practice Address - Street 2:SUITE A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-2103
Practice Address - Country:US
Practice Address - Phone:505-554-2409
Practice Address - Fax:505-554-2876
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK27076207ZP0101X
NMMD2013-0554207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology