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Individual

DR. BENJAMIN B BLACKMON JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
109 BLARNEY DR, COLUMBIA, SC 29223-6244
(803) 865-8200
(803) 419-7910
Mailing address
1117 GLENWOOD CT, COLUMBIA, SC 29204-3361
(803) 467-4171

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
10460
SC
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
10460
SC
207LP2900X
Pain Medicine (Anesthesiology) Physician
10460
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
050028865
RR MEDICARE
SC
01
104602
SELECT HEALTH
SC
05
104602
SC
01
2000024
CCP
SC
01
4129447
AETNA
SC
01
77778
MEDCOST
SC
Enumeration date
10/12/2006
Last updated
01/31/2025
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