Provider Demographics
NPI:1588965271
Name:JACALYN BLACKWELL-WHITE, M,D., PA
Entity type:Organization
Organization Name:JACALYN BLACKWELL-WHITE, M,D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIFTON
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-521-7337
Mailing Address - Street 1:3527 N ROLLING RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2223
Mailing Address - Country:US
Mailing Address - Phone:410-521-7337
Mailing Address - Fax:410-521-7377
Practice Address - Street 1:3527 N ROLLING RD
Practice Address - Street 2:SUITE 1
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-2223
Practice Address - Country:US
Practice Address - Phone:410-521-7337
Practice Address - Fax:410-521-7377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty