Individual
LUKE JOHNATHAN BLANKENHEIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
8926 WOODYARD RD, SUITE 701, CLINTON, MD 20735-4220
(301) 856-1682
(301) 856-8214
Mailing address
8926 WOODYARD RD, SUITE 701, CLINTON, MD 20735-4220
(301) 856-1682
(301) 856-8214
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C0004416
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C0004416
MARYLAND LICENSE
—
01
—
CI2264
RAILROAD MEDICARE GROUP PTAN
—
01
—
P00992732
RAILROAD MEDICARE INDIVIDUAL PTAN
—
Enumeration date
01/31/2011
Last updated
02/13/2012
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