Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | D65984 | MD |
NPI | 1306982954 |
---|---|
Provider Name | Dr. Scott M Blackman |
First Address | Ellicott City, MD 21042-5115 |
Second Address | Baltimore, MD 21287-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 08/07/2007 |