Provider Demographics
NPI:1588603575
Name:BLANKENSHIP, SUSAN ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN ELIZABETH
Middle Name:
Last Name:BLANKENSHIP
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 1:233 NOWELL FARME RD
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:MA
Mailing Address - Zip Code:01741-1827
Mailing Address - Country:US
Mailing Address - Phone:781-672-2250
Mailing Address - Fax:
Practice Address - Street 1:482 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-1402
Practice Address - Country:US
Practice Address - Phone:781-672-2250
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA73715207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine