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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: August 09, 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
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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 NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

AUDREY P SENIOR APRN
Nurse Practitioner (Family)
20 YORK ST
NEW HAVEN, CT 06510
South Central Connecticut Planning Region (203) 688-5860
DR. YEISID F FIGUEREDO M.D.
Pediatrics (Neonatal-Perinatal Medicine)
20 YORK ST, DEPT OF NEONATOLOGY
NEW HAVEN, CT 06510
South Central Connecticut Planning Region (203) 688-2320
YALE NEW HAVEN HOSPITAL
Durable Medical Equipment & Medical Supplies (Customized Equipment)
20 YORK ST
NEW HAVEN, CT 06510
South Central Connecticut Planning Region (203) 688-2046
TAYLOR KINGSTON
Dietitian, Registered
20 YORK ST, FOOD AND NUTRITION EPB806
NEW HAVEN, CT 06510
South Central Connecticut Planning Region (203) 688-9185
DR. TRAVIS DANIEL BONTRAGER MD
Hospitalist
20 YORK ST
NEW HAVEN, CT 06510
South Central Connecticut Planning Region (203) 688-1734
NEEHARIKA THOTTEMPUDI MBBS
Psychiatry & Neurology (Neurology)
20 YORK ST
NEW HAVEN, CT 06510
South Central Connecticut Planning Region (203) 688-4242
TERESA JOSEPH D.O.
Internal Medicine (Nephrology)
20 YORK ST
NEW HAVEN, CT 06510
South Central Connecticut Planning Region (203) 737-8894
MR. BRAD ST. MARTIN MD
Obstetrics & Gynecology
20 YORK ST
NEW HAVEN, CT 06510
South Central Connecticut Planning Region (203) 688-4242

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Theresa Blickenstaff's NPI number?

The NPI number for Theresa Blickenstaff is 1003619388. It was assigned to this individual provider in the NPPES registry on March 31, 2025.

Where is Theresa Blickenstaff located?

Theresa Blickenstaff practices at 20 York St, New Haven, CT 06510. The listed phone number is (203) 688-4242.

What is Theresa Blickenstaff's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Theresa Blickenstaff enrolled in Medicare?

Yes. Theresa Blickenstaff is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Theresa Blickenstaff was last updated on May 24, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.