Individual
ANDREW DEATON BLODGETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
19830 ZION AVE, CORNELIUS, NC 28031-8495
(704) 384-1782
(704) 384-1783
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 316-1750
(704) 316-1755
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2006-00275
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5908164
—
NC
Enumeration date
02/13/2007
Last updated
06/11/2021
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