MEDICARE: GREGORY C BLACKWELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	372600000X	Adult Companion

General Provider Information

NPI Number	:	1518598721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY C BLACKWELL

Provider Business Mailing Address
First Line	:	2551 17TH ST NW APT 312
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20009-2851
Country	:	US
Telephone Number	:	202-765-8287
Fax Number	:

Provider Business Practice Location Address
First Line	:	2551 17TH ST NW APT 312
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20009-2851
Country	:	US
Telephone Number	:	202-765-8287
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2020
Last Update Date	:	01/28/2020

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Directions to “ GREGORY C BLACKWELL ” Practice Location

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