Provider Demographics
NPI:1558807925
Name:BLACKBURN PSYCHIATRY LLC
Entity Type:Organization
Organization Name:BLACKBURN PSYCHIATRY LLC
Other - Org Name:VINT BLACKBURN MD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MATHILDA
Authorized Official - Middle Name:
Authorized Official - Last Name:NANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-533-3995
Mailing Address - Street 1:132 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:MILLVALE
Mailing Address - State:PA
Mailing Address - Zip Code:15209-2524
Mailing Address - Country:US
Mailing Address - Phone:412-533-3995
Mailing Address - Fax:412-533-3998
Practice Address - Street 1:132 HOWARD ST
Practice Address - Street 2:
Practice Address - City:MILLVALE
Practice Address - State:PA
Practice Address - Zip Code:15209-2524
Practice Address - Country:US
Practice Address - Phone:412-533-3995
Practice Address - Fax:412-533-3998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-10
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4543992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty