Provider Demographics
NPI:1720099401
Name:BLACKSTONE, ROBIN PAVLICH (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:PAVLICH
Last Name:BLACKSTONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:PAVLICH
Other - Last Name:STAERKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1441 N 12TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2837
Mailing Address - Country:US
Mailing Address - Phone:602-521-3050
Mailing Address - Fax:
Practice Address - Street 1:1441 N 12TH ST FL 2
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2837
Practice Address - Country:US
Practice Address - Phone:602-521-3050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24199208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZF70195Medicare UPIN
AZZ27446Medicare ID - Type Unspecified