Provider Demographics
NPI:1396905055
Name:BLANCHE, MERCEDES M (MD)
Entity type:Individual
Prefix:DR
First Name:MERCEDES
Middle Name:M
Last Name:BLANCHE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MERCEDES
Other - Middle Name:M
Other - Last Name:BLANCHE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2955
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-8955
Mailing Address - Country:US
Mailing Address - Phone:845-452-2786
Mailing Address - Fax:845-224-3979
Practice Address - Street 1:290 BROADWAY STE 4
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-5448
Practice Address - Country:US
Practice Address - Phone:845-764-4999
Practice Address - Fax:845-224-3979
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY248388208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics