Provider Demographics
NPI:1144858077
Name:BLACKSTONE, OLIVIA CHARLOTTE (DO)
Entity type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:CHARLOTTE
Last Name:BLACKSTONE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 81064
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44181-0064
Mailing Address - Country:US
Mailing Address - Phone:602-494-5050
Mailing Address - Fax:866-777-2248
Practice Address - Street 1:11209 N TATUM BLVD STE 255
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-6061
Practice Address - Country:US
Practice Address - Phone:602-494-5050
Practice Address - Fax:866-777-2248
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ011075207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology