Provider Demographics
NPI:1558581314
Name:BLANCHFIELD, COLLEEN A (MD)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:A
Last Name:BLANCHFIELD
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 1:11490 COMMERCE PARK DR
Mailing Address - Street 2:SUITE 420
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-1557
Mailing Address - Country:US
Mailing Address - Phone:703-481-9111
Mailing Address - Fax:703-707-8657
Practice Address - Street 1:11490 COMMERCE PARK DR
Practice Address - Street 2:SUITE 420
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-1557
Practice Address - Country:US
Practice Address - Phone:703-481-9111
Practice Address - Fax:703-707-8657
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010483382084N0400X, 2084P0800X, 2084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F40943Medicare UPIN
071949Medicare ID - Type Unspecified