Individual
JACOB NAZARETH BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5801 BREMO RD, RICHMOND, VA 23226-1907
(804) 285-2011
Mailing address
5801 BREMO RD, RICHMOND, VA 23226-1907
(804) 285-2011
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2020-04293
NC
207RC0000X
Cardiovascular Disease Physician
0101286596
VA
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
MT227978
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/30/2017
Last updated
09/08/2025
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