Healthcare Provider Details

I. General information

NPI: 1609832104
Provider Name (Legal Business Name): JAMES EDWARD BLACKSMITH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 02/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

689 YORKTOWN RD
LEWISBERRY PA
17339-9258
US

IV. Provider business mailing address

946 INDIANA AVE
LEMOYNE PA
17043-1406
US

V. Phone/Fax

Practice location:
  • Phone: 717-932-4050
  • Fax: 717-932-8072
Mailing address:
  • Phone: 717-761-2066
  • Fax: 717-418-2389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS002954L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: