Individual
DR. SAMUEL CHARLES BLACKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, PHD
Contact information
Practice address
34TH & CIVIC CENTER BLVD, CHILDREN'S HOSPITAL OF PHILADELPHIA, PHILADELPHIA, PA 19104
(215) 590-1000
Mailing address
100 N 20TH ST STE 301, CHCA, PHILADELPHIA, PA 19103-1454
(215) 567-2422
(215) 977-8864
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
MD433904
PA
2080P0207X
Pediatric Hematology & Oncology Physician
220358
MA
2080P0207X
Pediatric Hematology & Oncology Physician
Primary
MD433904
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11372260
CAQH ID
PA
01
—
20074409
AMERIHEALTH MERCY HEALTH PLAN - GENERAL PEDIATRICS
PA
01
—
20074413
AMERIHEALTH MERCY HEALTH PLAN --ONCOLOGY
PA
01
—
30052688
KEYSTONE MERCY HEALTH PLAN --GENERAL PEDIATRICS
PA
01
—
30052689
KEYSTONE MERCY HEALTH PLAN --ONCOLOGY
PA
05
—
64065881
—
KY
Enumeration date
07/07/2005
Last updated
10/03/2008
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