Individual
MARI BLACKBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
7801 YORK RD, SUITE 102, TOWSON, MD 21204-7446
(410) 769-4920
(410) 296-4205
Mailing address
7801 YORK RD, SUITE 102, TOWSON, MD 21204-7446
(410) 769-4920
(410) 296-4205
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
H45300
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8895LC348
MEDICARE PROVIDER NUMBER
—
Enumeration date
01/27/2006
Last updated
09/20/2007
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