MEDICARE: CURT D BLACKLOCK DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	C20003134	DE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	DO0167	OTHER	DE	DCS

General Provider Information

NPI Number	:	1467465450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CURT D BLACKLOCK DO

Provider Business Mailing Address
First Line	:	2600 GLASGOW AVE
Second Line	:	STE 218
City	:	NEWARK
State	:	DE
Zip	:	19702-5704
Country	:	US
Telephone Number	:	302-392-2337
Fax Number	:	302-392-2333

Provider Business Practice Location Address
First Line	:	2600 GLASGOW AVE
Second Line	:	STE 218
City	:	NEWARK
State	:	DE
Zip	:	19702-5704
Country	:	US
Telephone Number	:	302-392-2337
Fax Number	:	302-392-2333

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	03/07/2023

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