Provider Demographics
NPI:1447336615
Name:BLAKESLEE AND EICHELBERGER LLC
Entity type:Organization
Organization Name:BLAKESLEE AND EICHELBERGER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT BLAKESLEE & EICHELBERGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:BLAKESLEE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:410-544-0053
Mailing Address - Street 1:479 JUMPERS HOLE RD
Mailing Address - Street 2:STE 304A BLAKESLEE & EICHELBERGER LLC
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146
Mailing Address - Country:US
Mailing Address - Phone:410-544-0053
Mailing Address - Fax:410-544-7830
Practice Address - Street 1:479 JUMPERS HOLE RD
Practice Address - Street 2:STE 304A BLAKESLEE & EICHELBERGER LLC
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146
Practice Address - Country:US
Practice Address - Phone:410-544-0053
Practice Address - Fax:410-544-7830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH44184207R00000X
MDD42146207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KJ46BLOtherBCBS
W285OtherNATL CAPITAL AREA
W285OtherBCBS
KJ46BLOtherCAREFIRST
W285OtherBCBS