| Jesse A Blackman, Md, Pa | |
|
109 S. Sycamore Street Fremont NC 27830 | |
| (919) 242-5550 | |
| (919) 242-6428 |
| Full Name | Jesse A Blackman, Md, Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 109 S. Sycamore Street, Fremont, North Carolina |
| Authorized Official Name and Position | Jesse A Blackman (PRESIDENT) |
| Authorized Official Contact | 9192425550 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jesse A Blackman, Md, Pa 109 S. Sycamore Street P O Box 878 Fremont NC 27830 Ph: (919) 242-5550 | Jesse A Blackman, Md, Pa 109 S. Sycamore Street Fremont NC 27830 Ph: (919) 242-5550 |
| NPI Number | 1407887862 |
|---|---|
| Provider Enumeration Date | 07/05/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407887862 | NPI | - | NPPES |
| 8916000 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 18609 (North Carolina) | Primary |
Goshen Medical Center-fremont Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 109 S Sycamore St, Fremont, NC 27830 Phone: 919-242-4382 Fax: 919-242-4526 |