Individual
DR. GLENN A BLACKWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1701 N SENATE BLVD, ROOM 1204A, INDIANAPOLIS, IN 46202-1239
(317) 962-6793
(317) 962-8281
Mailing address
250 N SHADELAND AVE, STE 200, INDIANAPOLIS, IN 46219-4959
(317) 963-2720
(317) 962-4343
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01056409A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000246029
ANTHEM BCBS
IN
05
—
200404230
—
IN
01
—
P00130615
RAILROAD MEDICARE
IN
01
—
P00175757
RAILROAD MEDICARE
IN
Enumeration date
06/13/2006
Last updated
12/27/2019
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