Provider Demographics
NPI:1164833059
Name:BLACKBURN, MELISSA (DO)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:312 PROFESSIONAL VIEW DR
Mailing Address - Street 2:BLDG 300
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-7904
Mailing Address - Country:US
Mailing Address - Phone:732-431-1616
Mailing Address - Fax:732-866-7962
Practice Address - Street 1:1200 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3720
Practice Address - Country:US
Practice Address - Phone:215-481-6784
Practice Address - Fax:215-481-4787
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB10234200207V00000X
PAOT015786207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology