Tamika Blackburn, M.D.
Individual provider Active NPI Internal Medicine Physician · Wethersfield, CT
NPI 1053593079 · NPPES record last updated Oct 14, 2019
Key facts
- NPI
- 1053593079
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 53376 (CT)
- Practice address
- 1260 Silas Deane Hwy Ste 103
Wethersfield, CT 06109-4363 - Phone
- (860) 563-9518
- Fax
- (860) 257-0088
- NPI assigned
- Nov 30, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20141021000070 | CT | Practitioner - Internal Medicine | 8123184751 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prohealth Physicians PC | Internal Medicine | Current |
Accepting new patients |
| The New York and Presbyterian Hospital | Past | Accepting new patients | |
| The New York and Presbyterian Hospital | Internal Medicine | Past | Accepting new patients |
Locations
3 Farm Glen Blvd
Farmington, CT 06032
Phone (860) 284-5200
1260 Silas Deane Hwy
Ste 103
Wethersfield, CT 06109
Phone (860) 257-4814
115 Spencer St
Winsted, CT 06098
Phone (860) 738-5810
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 247841 | NY | |
| Internal Medicine Physician | 207R00000X | 53376 | CT | Yes |
Addresses
Primary practice location
1260 Silas Deane Hwy Ste 103
Wethersfield, CT 06109-4363
Mailing address
1260 Silas Deane Hwy Ste 103
Wethersfield, CT 06109-4363
Phone (860) 563-9518
Other providers in Wethersfield, CT
- Rebecca Betancourt
- Joan E Biagioni
- Lisa E Bianchi
- Kristine Faulknham Birdsall
- BKFG Patient Care Solutions
- Christina Nithda Bouaphone
- Alicia Bravo
- Brighid Brennan
- Deborah Ann Broadley
- Rohan Brown
All providers in Wethersfield, CT · Internal Medicine Physician in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 14, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.