Provider Demographics
NPI:1518025535
Name:BLAUSTEIN, JOHN CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CHARLES
Last Name:BLAUSTEIN
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:PO BOX 22405
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-0405
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:SANTA BARBARA COTTAGE HOSPITAL
Practice Address - Street 2:PUEBLO AT BATH
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93102
Practice Address - Country:US
Practice Address - Phone:805-569-7367
Practice Address - Fax:805-569-8354
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG654820207ZH0000X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA220006228OtherRAILROAD MEDICARE
CAZZZ42967ZOtherBLUE SHIELD
CA1356409379OtherGROUP NPI
CA00G654820Medicaid
CAG654820OtherMEDICAL BOARD OF CA
CA00G654820Medicaid
CAG654820OtherMEDICAL BOARD OF CA
CA220006228OtherRAILROAD MEDICARE
CAHW8260Medicare PIN