Provider Demographics
NPI:1710026018
Name:BLACHARSH, PHYLLIS SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:SUSAN
Last Name:BLACHARSH
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 1:680 HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-3525
Mailing Address - Country:US
Mailing Address - Phone:516-485-4527
Mailing Address - Fax:516-485-4527
Practice Address - Street 1:680 HOWARD AVE
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-3525
Practice Address - Country:US
Practice Address - Phone:516-485-4527
Practice Address - Fax:516-485-4527
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA80282207R00000X
NY180127207R00000X
CAG76403207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine