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General NPI Number Information
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NPI Number | 1013821206
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Entity Type | Organization
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Legal Business Name | BLACKMER MEDICAL, LLC
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Dates
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Enumeration Date | 10/02/2026
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Last Update Date | 10/02/2026
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Provider Practice Location Address
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Address Line | 1030 LOFTIS BLVD STE 101
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-2999
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Country | US
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Telephone | 757-596-7938
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Fax |
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Provider Business Mailing Address
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Address Line | 11712 JEFFERSON AVE # 763
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-4406
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Country | US
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Telephone | 612-280-2767
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHANNON BLACKMER
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Credential |
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Telephone | 612-280-2767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number |
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License Number State | NULL
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