Provider Demographics
NPI:1922143296
Name:BLANK, EUGENIA (MD)
Entity Type:Individual
Prefix:
First Name:EUGENIA
Middle Name:
Last Name:BLANK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EUGENIA
Other - Middle Name:
Other - Last Name:SHIKHANOVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:170 GOVERNORS AVE STE 258
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-1643
Mailing Address - Country:US
Mailing Address - Phone:781-213-5201
Mailing Address - Fax:781-213-5255
Practice Address - Street 1:170 GOVERNORS AVE STE 258
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-1643
Practice Address - Country:US
Practice Address - Phone:781-213-5201
Practice Address - Fax:781-213-5255
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2305672084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology