Provider Demographics
NPI:1871560029
Name:BLACKINTON, CHARLES HARRY (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:HARRY
Last Name:BLACKINTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 SOUTH DENNIS ROAD
Mailing Address - Street 2:PO BOX 456
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210
Mailing Address - Country:US
Mailing Address - Phone:609-465-0018
Mailing Address - Fax:609-465-4864
Practice Address - Street 1:303 SOUTH DENNIS ROAD
Practice Address - Street 2:
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210
Practice Address - Country:US
Practice Address - Phone:609-465-0018
Practice Address - Fax:609-465-4864
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA294742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ486792Medicare ID - Type Unspecified
E57208Medicare UPIN