Provider Demographics
NPI:1043546336
Name:BLANKENSHIP, MARC EDWARD (RPA)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:EDWARD
Last Name:BLANKENSHIP
Suffix:
Gender:M
Credentials:RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 KINGSTON PIKE STE 540
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-5054
Mailing Address - Country:US
Mailing Address - Phone:865-584-7376
Mailing Address - Fax:
Practice Address - Street 1:5401 KINGSTON PIKE STE 540
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5054
Practice Address - Country:US
Practice Address - Phone:865-584-7376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRA 0000000010243U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant