Individual
DAVID BLACKWELL JESSUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1001 NEWMAN RD, NEW BERN, NC 28562-5253
(252) 635-6777
(252) 634-3183
Mailing address
PO BOX 896206, CHARLOTTE, NC 28289-6206
(252) 635-6777
(252) 634-3183
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
2013-02325
NC
207RC0000X
Cardiovascular Disease Physician
2548
WI
207RI0011X
Interventional Cardiology Physician
2013-02325
NC
207RI0011X
Interventional Cardiology Physician
2548
WI
207RI0011X
Interventional Cardiology Physician
Primary
D90075
MD
207RI0011X
Interventional Cardiology Physician
DR.0063644
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0279973
L&I AND CRIME VICTIMS FOR PHMG
WA
05
—
1477502136
—
WA
01
—
7503052
AETNA
WA
01
—
82107
L&I AND CRIME VICTIMS FOR SJMC
WA
05
—
8399099
—
WA
01
—
A057
REGENCE BLUE SHIELD
WA
01
—
G8896098
MEDICARE PIN FOR SJMC
WA
01
—
G8900993
MEDICARE PIN FOR PHMG
WA
05
—
MD7029W
—
AK
01
—
P00194456
RAILROAD MEDICARE
WA
Enumeration date
05/09/2006
Last updated
04/18/2023
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