1. Home
  2. Directory
  3. Connecticut
  4. New Haven
  5. Student In An Organized Health Care Education Training Program
  6. NPI Profile

THERESA MARIE BLICKENSTAFF MD
NPI 1003619388
Student in an Organized Health Care Education/Training Program in New Haven, CT

Active since March 31, 2025PECOS Enrolled
20 YORK ST, NEW HAVEN, CT 06510(203) 688-4242 Get Directions Write a Review

NPPES record last updated: May 24, 2026. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: May 24, 2026, Mar 31, 2025 (2 updates tracked since 2025).

About Theresa Marie Blickenstaff Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

THERESA MARIE BLICKENSTAFF MD (NPI 1003619388) is an individual student in an organized health care education/training program in New Haven, Connecticut and active in the NPI registry since March 2025. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1003619388
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameTHERESA MARIE BLICKENSTAFFCredential: MD
Location Address20 YORK STNew Haven, CT 06510-3220
Mailing Address20 York StNew Haven, CT 06510-3220 · (203) 688-4242
Phone(203) 688-4242
Sole ProprietorNo
Enumeration DateMarch 31, 2025
Last NPPES UpdateMay 24, 20262 updates tracked since enumeration
NPPES CertifiedMay 24, 2026
✔ NPI 1003619388 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

20 YORK ST, New Haven, CT 06510
Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Theresa Marie Blickenstaff Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location


The following 20 providers are registered at the same or a nearby location.

MELIH ARICI MD
Radiology (Diagnostic Radiology)
20 YORK ST, YALE NEW HAVEN HOSPITAL
NEW HAVEN, CT 06510
South Central Connecticut Planning Region (203) 785-7998
DAVID CHRISTOPHER CONE MD
Emergency Medicine
20 YORK ST, YNHH SOUTH PAVILION 218
NEW HAVEN, CT 06510
South Central Connecticut Planning Region (203) 688-2222
KEVIN JOHN BURNS PA C
Physician Assistant
20 YORK ST, YALE NEW HAVEN HOSPITAL SOUTH PAVILION 218
NEW HAVEN, CT 06510
South Central Connecticut Planning Region (203) 688-2222
MAURICE J MAHONEY MD
Medical Genetics (Clinical Genetics (M.D.))
20 YORK ST, YALE CHILDREN'S HOSPITAL, WEST PAVILION, 2ND FLOOR
NEW HAVEN, CT 06510
South Central Connecticut Planning Region (203) 785-2660
MARGRETTA R SEASHORE MD
Medical Genetics (Clinical Genetics (M.D.))
20 YORK ST, CHILDREN'S HOSPITAL AT YALE, WEST PAVILION, 2ND FLOOR
NEW HAVEN, CT 06510
South Central Connecticut Planning Region (203) 785-2660
PAUL HENRI DESAN MD
Psychiatry & Neurology (Psychiatry)
20 YORK ST
NEW HAVEN, CT 06510
South Central Connecticut Planning Region (203) 688-2619
LIVA ANDREJEVA-WRIGHT MD
Radiology (Diagnostic Radiology)
20 YORK ST, YALE NEW HAVEN HOSPITAL-SOUTH PAVILLION-2ND FL
NEW HAVEN, CT 06510
South Central Connecticut Planning Region (203) 688-2433
KELLY ANNETTE MARTENS PA C
Physician Assistant
20 YORK ST, YALE NEW HAVEN HOSPTIAL EMERGENCY DEPARTMENT
NEW HAVEN, CT 06510
South Central Connecticut Planning Region (203) 688-2222
CARLO BRUNO BIFULCO MD
Pathology (Anatomic Pathology)
20 YORK ST, YALE-NEW HAVEN CHILDREN'S HOSPITAL-EP 2608
NEW HAVEN, CT 06510
South Central Connecticut Planning Region (203) 785-3624
KAREN JEAN JUBANYIK-BARBER MD
Emergency Medicine
20 YORK ST, YNHH SOUTH PAVILION 218
NEW HAVEN, CT 06510
South Central Connecticut Planning Region (203) 688-2222
RISA HILLARY KENT MD
Radiology (Diagnostic Radiology)
20 YORK ST, YALE NEW HAVEN HOSPITAL SOUTH PAVILION 2ND FLOOR
NEW HAVEN, CT 06510
South Central Connecticut Planning Region (203) 688-2433
RICHARD TORRES MD
Pathology (Hematology)
20 YORK ST, YNHH, CLINIC BUILDING, ROOM 407
NEW HAVEN, CT 06510
South Central Connecticut Planning Region (203) 785-2153
HARRY C MOSCOVITZ MD
Emergency Medicine
20 YORK ST, YNHH SOUTH PAVILION - ROOM 218
NEW HAVEN, CT 06510
South Central Connecticut Planning Region (203) 688-2222
JOHN E ARUNY MD
Radiology (Vascular & Interventional Radiology)
20 YORK ST, YNHH SOUTH PAVILION - 2ND FLOOR
NEW HAVEN, CT 06510
South Central Connecticut Planning Region (203) 688-2433
ELIZABETH DOLORES BROWNE PAC
Physician Assistant
20 YORK ST, YALE NEW HAVEN HOSPITAL
NEW HAVEN, CT 06510
South Central Connecticut Planning Region (203) 688-2222
MANJU L PRASAD M.D.
Pathology (Anatomic Pathology)
20 YORK ST, EP#2-608B
NEW HAVEN, CT 06510
South Central Connecticut Planning Region (203) 737-4862
MICHAEL EDWIN HODSDON MD
Pathology (Clinical Pathology/Laboratory Medicine)
20 YORK ST, YNHH CB 407
NEW HAVEN, CT 06510
South Central Connecticut Planning Region (203) 785-2153
MARK J SHLOMCHIK MD
Pathology (Clinical Pathology/Laboratory Medicine)
20 YORK ST, YNHH, CLINIC BUILDING, ROOM 407
NEW HAVEN, CT 06510
South Central Connecticut Planning Region (203) 785-2153
HENRY M RINDER MD
Pathology (Clinical Pathology/Laboratory Medicine)
20 YORK ST, YNHH - CLINIC BUILDING, ROOM 407
NEW HAVEN, CT 06510
South Central Connecticut Planning Region (203) 785-2153
CHARLES C DUNCAN MD
Neurological Surgery
20 YORK ST, YNHH- CHILDREN'S HOSP. - WEST PAVILLION 2ND FL
NEW HAVEN, CT 06510
South Central Connecticut Planning Region (203) 785-2809

Frequently Asked Questions

What is Theresa Blickenstaff's NPI number?

The NPI number assigned to this healthcare provider is 1003619388, enumerated as an "individual" on March 31, 2025.

Where is the provider located?

The provider is located at 20 YORK ST NEW HAVEN, CT 06510 and the phone number is (203) 688-4242.

What is the provider's specialty?

Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.