Provider Demographics
NPI:1164742409
Name:BLANKENSHIP, JESSE LARRY (DPM)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:LARRY
Last Name:BLANKENSHIP
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3222 EDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-2904
Mailing Address - Country:US
Mailing Address - Phone:301-538-9170
Mailing Address - Fax:
Practice Address - Street 1:3222 EDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2904
Practice Address - Country:US
Practice Address - Phone:301-538-9170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPO595213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist