Blackwell-White, Jacalyn Cecelia

Blackwell-White, Jacalyn Cecelia is an sole proprietor health care provider with primary practice located at 5400 Old Court Rd Ste 300B , Randallstown MD 21133-5100. She recently has only one registered license in Allopathic & Osteopathic Physicians / Adolescent Medicine, which is considered as her primary health care specialty. Blackwell-White, Jacalyn Cecelia can be contacted via phone (410) 521-7337.

Contact Information

Primary practice address
5400 Old Court Rd Ste 300B Randallstown MD 21133-5100
Phone: (410) 521-7337
Fax: (410) 521-7377
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Adolescent Medicine 2080A0000X D35187 Maryland

Profile Details

NPI number 1548355506
LBN Legal business name Blackwell-White, Jacalyn Cecelia
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 4th, 2006
Last updated Apr 4th, 2019 - about 7 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1548355506 NPPES
Maryland MEDICAID 443261400
Maryland Other 1789J

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