Blackstone, Mercedes M
Blackstone, Mercedes M is an individual health care provider with primary practice located at 3401 Civic Center Blvd Children'S Hospital Of Philadelphia - Emergency Med, Philadelphia PA 19104-4319. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Pediatric Emergency Medicine. Allopathic & Osteopathic Physicians / Pediatric Emergency Medicine is her primary health care specialty. Blackstone, Mercedes M can be contacted via phone (215) 590-1944.Contact Information
Primary practice address
3401 Civic Center Blvd Children'S Hospital Of Philadelphia - Emergency Med
Philadelphia PA 19104-4319
Phone: (215) 590-1944
Fax: (215) 590-4454
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | MD424581 | Pennsylvania |
| Allopathic & Osteopathic Physicians / Pediatric Emergency Medicine | 2080P0204X | MD424581 | Pennsylvania |
Profile Details
| NPI number | 1376564179 |
|---|---|
| LBN Legal business name | Blackstone, Mercedes M |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 21st, 2006 |
| Last updated | Apr 16th, 2013 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1376564179 | NPPES |
| Pennsylvania | MEDICAID | 101521060 | |
| Pennsylvania | MEDICAID | 0105422 |
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