Provider Demographics
NPI:1699762252
Name:BLACKY, ALBERT ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:ROBERT
Last Name:BLACKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:9330 PARK WEST BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4308
Mailing Address - Country:US
Mailing Address - Phone:865-691-4850
Mailing Address - Fax:865-694-8018
Practice Address - Street 1:9330 PARK WEST BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4308
Practice Address - Country:US
Practice Address - Phone:865-691-4850
Practice Address - Fax:865-694-8018
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN28082207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNG27610Medicare UPIN
TN3734041Medicare PIN
TN3888252Medicare PIN
00057276Medicare PIN