Individual
JONATHAN WILLIAM BLANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2430 EMERALD PL STE 201, GREENVILLE, NC 27834-5743
(252) 752-2140
Mailing address
2430 EMERALD PL STE 201, GREENVILLE, NC 27834-5743
(252) 752-2140
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
32991
NC
208VP0014X
Interventional Pain Medicine Physician
32991
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050047831
RAILROAD-MEDICARE
NC
01
—
132EA
BCBS NC
NC
01
—
24501
PARTNERS
NC
01
—
57300
MEDCOST
NC
05
—
89132EA
—
NC
01
—
9211380
CIGNA
NC
Enumeration date
08/31/2006
Last updated
10/24/2022
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