Provider Demographics
NPI:1043284722
Name:BLACKSTONE, SHERRI E (MD)
Entity type:Individual
Prefix:
First Name:SHERRI
Middle Name:E
Last Name:BLACKSTONE
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:PO BOX 789967
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-9967
Mailing Address - Country:US
Mailing Address - Phone:484-622-7395
Mailing Address - Fax:484-622-7399
Practice Address - Street 1:2010 N BROAD ST STE 100
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-1004
Practice Address - Country:US
Practice Address - Phone:215-997-9441
Practice Address - Fax:215-997-6730
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD069536L207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7491423OtherAETNA
PA2147675000OtherDBC
PA7491423OtherAETNA
PA2147675000OtherDBC