Provider Demographics
NPI:1952637993
Name:BLANKS, MARY SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:SUSAN
Last Name:BLANKS
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 1:36 EAST RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:SKILLMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08558
Mailing Address - Country:US
Mailing Address - Phone:908-874-4792
Mailing Address - Fax:908-874-4792
Practice Address - Street 1:36 EAST RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:SKILLMAN
Practice Address - State:NJ
Practice Address - Zip Code:08558
Practice Address - Country:US
Practice Address - Phone:908-874-4792
Practice Address - Fax:908-874-4792
Is Sole Proprietor?:No
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036062151207V00000X
NJ25MA87778500207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology