Active NPI
Charles Lee Blair, M.D.
- Psychiatry Physician
- West Hartford, CT
National Provider Identifier
1467591552
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 024703
- Practice address
- 836 Farmington Ave Ste 217B
West Hartford, CT 06119-1545 - Phone
- (860) 523-1451
- Fax
- (860) 523-1437
- NPI assigned
- Feb 5, 2007
- Last updated
- Feb 17, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 024703 | CT | Primary |
Addresses
Primary practice location
836 Farmington Ave Ste 217B
West Hartford, CT 06119-1545
Mailing address
836 Farmington Ave Ste 217B
West Hartford, CT 06119-1545
Phone (860) 523-1451
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1247030 | Medicaid | CT | |
| 010024703CT02 | Other | CT | ANTHEM ID NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 1, 2014 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 024703 | CT | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170633600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1676592000000",
"number": "1467591552",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "836 FARMINGTON AVE STE 217B",
"city": "WEST HARTFORD",
"state": "CT",
"postal_code": "061191545",
"telephone_number": "860-523-1451",
"fax_number": "860-523-1437"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "836 FARMINGTON AVE STE 217B",
"city": "WEST HARTFORD",
"state": "CT",
"postal_code": "061191545",
"telephone_number": "860-523-1451",
"fax_number": "860-523-1437"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLAIR",
"first_name": "CHARLES",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-05",
"last_updated": "2023-02-17",
"certification_date": "2023-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CT",
"license": "024703",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1247030",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM ID NUMBER",
"identifier": "010024703CT02",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Hartford, CT
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- Laura Celeste Black, M.D.
- Patricia Black, PT
- Donna Marie Blain, M.A., CCC-A
- Shannon Blake, PA
- Charvel Lee Renee Blanco, LO
- BLC-Chatfield, LLC (Brookdale Chatfield)
- Amanda Lynn Bloking
- Bloom Natural Health, PLLC (Bloom)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.