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General NPI Number Information
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NPI Number | 1275094294
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Entity Type | Individual
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Provider Name | MARISSA BLACKWELL MD
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Gender | Female
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Dates
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Enumeration Date | 03/31/2019
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Last Update Date | 07/10/2024
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Provider Practice Location Address
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Address Line | 200 HYGEIA DR STE 1420
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City | NEWARK
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State | DE
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Zip | 19713-2049
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Country | US
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Telephone | 302-623-3017
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Fax | 302-266-9962
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Provider Business Mailing Address
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Address Line | 1215 LEE ST. BOX 800394
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22908-0816
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Country | US
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Telephone | 434-924-5306
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Fax | 434-982-1064
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | C1-0027182
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License Number State | DE
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