Healthcare Provider Details

I. General information

NPI: 1437562444
Provider Name (Legal Business Name): BENJAMIN BLACKWOOD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2014
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ELLIOT WAY
MANCHESTER NH
03103-3502
US

IV. Provider business mailing address

1 ELLIOT WAY
MANCHESTER NH
03103-3599
US

V. Phone/Fax

Practice location:
  • Phone: 603-663-2844
  • Fax:
Mailing address:
  • Phone: 603-663-2844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number38994
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: