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General NPI Number Information
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NPI Number | 1275792038
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Entity Type | Individual
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Provider Name | RYAN GRAHAM BLACKMAN D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/06/2008
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Last Update Date | 04/08/2013
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Provider Practice Location Address
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Address Line | 9501 ROOSEVELT BLVD SUITE 305
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City | PHILADELPHIA
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State | PA
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Zip | 19114-1025
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Country | US
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Telephone | 215-969-4917
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Fax | 215-969-5875
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Provider Business Mailing Address
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Address Line | FRONT ST AND ERIE AVE ST CHRISTOPHERS HOSPITAL FOR CHILDREN
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City | PHILADELPHIA
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State | PA
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Zip | 19134
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Country | US
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Telephone | 215-427-5000
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | OT012097
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License Number State | PA
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