Individual
DARRELL KEVIN BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1490 PARK AVE NW, SUITE 5, NORTON, VA 24273-1631
(276) 439-1440
(276) 439-1441
Mailing address
1490 PARK AVE NW, SUITE 5, NORTON, VA 24273-1631
(276) 439-1440
(276) 439-1441
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0102050073
VA
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
0102050073
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1710079819
—
VA
Enumeration date
09/28/2006
Last updated
01/27/2017
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