Provider Demographics
NPI:1194040725
Name:BLAYLOCK, BARBARA LAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:LAINE
Last Name:BLAYLOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6225 MAZWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3527
Mailing Address - Country:US
Mailing Address - Phone:301-564-1249
Mailing Address - Fax:
Practice Address - Street 1:6225 MAZWOOD RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3527
Practice Address - Country:US
Practice Address - Phone:301-564-1249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0026900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB55405Medicare UPIN