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General NPI Number Information
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NPI Number | 1821187899
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Entity Type | Individual
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Provider Name | CHARLES SAMUEL BLACKADAR M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1 BOONE RD NAVAL HOSPITAL
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City | BREMERTON
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State | WA
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Zip | 98312-1894
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Country | US
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Telephone | 360-475-4426
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Fax | 360-475-4344
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Provider Business Mailing Address
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Address Line | 5802 LONDONDERRY LOOP NW
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City | BREMERTON
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State | WA
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Zip | 98312-1197
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Country | US
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Telephone | 360-692-2276
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 37686
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License Number State | WA
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