Provider Demographics
NPI:1215954763
Name:MIDDLETON, BLACKFORD (MD)
Entity type:Individual
Prefix:
First Name:BLACKFORD
Middle Name:
Last Name:MIDDLETON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 W END AVE
Mailing Address - Street 2:VANDERBILT UNIVERSITY MEDICAL CENTER
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1042
Mailing Address - Country:US
Mailing Address - Phone:615-873-3705
Mailing Address - Fax:615-322-5610
Practice Address - Street 1:1211 MEDICAL CENTER DR
Practice Address - Street 2:VANDERBILT UNIVERSITY MEDICAL CENTER
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-0004
Practice Address - Country:US
Practice Address - Phone:615-322-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213036207R00000X
TN50052207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNE33600Medicare UPIN