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General NPI Number Information
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NPI Number | 1407887862
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Entity Type | Organization
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Legal Business Name | JESSE A BLACKMAN, MD, PA
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 109 S. SYCAMORE STREET
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City | FREMONT
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State | NC
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Zip | 27830
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Country | US
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Telephone | 919-242-5550
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Fax | 919-242-6428
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Provider Business Mailing Address
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Address Line | 109 S. SYCAMORE STREET P O BOX 878
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City | FREMONT
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State | NC
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Zip | 27830
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Country | US
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Telephone | 919-242-5550
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Fax | 919-242-6428
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JESSE A BLACKMAN
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Credential | M.D.
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Telephone | 919-242-5550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 18609
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License Number State | NC
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