Provider Demographics
NPI:1225225667
Name:CHARLES H. BLACKINTON, MD, PA
Entity type:Organization
Organization Name:CHARLES H. BLACKINTON, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:H
Authorized Official - Last Name:BLACKINTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-465-0018
Mailing Address - Street 1:303 COURTHOUSE- S.DENNIS RD
Mailing Address - Street 2:PO BOX 456
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-0456
Mailing Address - Country:US
Mailing Address - Phone:609-465-0018
Mailing Address - Fax:609-465-4264
Practice Address - Street 1:303 COURT HOUSE SOUTH DENNIS RD
Practice Address - Street 2:
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-1972
Practice Address - Country:US
Practice Address - Phone:609-465-0018
Practice Address - Fax:609-465-4264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA294742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ099387Medicare PIN