Provider Demographics
NPI:1972574416
Name:BLACHARSH, JILL JUNE (MD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:JUNE
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 1:224 MONTCLAIRE DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-1124
Mailing Address - Country:US
Mailing Address - Phone:505-264-5770
Mailing Address - Fax:
Practice Address - Street 1:224 MONTCLAIRE DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-1124
Practice Address - Country:US
Practice Address - Phone:505-264-5770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM86-1752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM85031326887301A154OtherCHAMPUS
NM201000856OtherPRESBYTERIAN HEALTH/SALUD
NM9605Medicaid
NMNM0023965OtherBCBS
AZ826589Medicaid
NM10009939OtherLOVELACE HEALTH/SALUD