Organization
JESSE A BLACKMAN, MD, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JESSE A BLACKMAN M.D. (PRESIDENT)
(919) 242-5550
Entity
Organization
Contact information
Practice address
109 S. SYCAMORE STREET, FREMONT, NC 27830
(919) 242-5550
(919) 242-6428
Mailing address
109 S. SYCAMORE STREET, P O BOX 878, FREMONT, NC 27830
(919) 242-5550
(919) 242-6428
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
18609
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8916000
—
NC
Enumeration date
07/05/2006
Last updated
08/22/2020
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