Provider Demographics
NPI:1457318198
Name:BLACKBURN, ROBERT EUGENE (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:EUGENE
Last Name:BLACKBURN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 EAST AVE
Mailing Address - Street 2:HILTON HEALTH CARE, P.C.
Mailing Address - City:HILTON
Mailing Address - State:NY
Mailing Address - Zip Code:14468-1333
Mailing Address - Country:US
Mailing Address - Phone:585-392-9100
Mailing Address - Fax:585-392-4020
Practice Address - Street 1:279 EAST AVE
Practice Address - Street 2:HILTON HEALTH CARE, P.C.
Practice Address - City:HILTON
Practice Address - State:NY
Practice Address - Zip Code:14468-1333
Practice Address - Country:US
Practice Address - Phone:585-392-9100
Practice Address - Fax:585-392-4020
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169882207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMD130DOtherPREFERRED CARE
NY5520487OtherAETNA
NY01039918Medicaid
NY000912964001OtherHEALTHNOW
NYCFP1698828OtherWORKERS COMPENSATION
NY6948OtherBLUE CROSS BLUE SHIELD
NY01039918Medicaid
NY13243CMedicare PIN