Provider Demographics
NPI:1245201573
Name:BLACKWELL, MICHAEL ALDRED III (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ALDRED
Last Name:BLACKWELL
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:408 8TH ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:N WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-4167
Mailing Address - Country:US
Mailing Address - Phone:336-667-7171
Mailing Address - Fax:336-667-1095
Practice Address - Street 1:408 8TH ST
Practice Address - Street 2:SUITE 4
Practice Address - City:N WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-4167
Practice Address - Country:US
Practice Address - Phone:336-667-7171
Practice Address - Fax:336-667-1095
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2015-05-20
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Provider Licenses
StateLicense IDTaxonomies
NC9500290207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0297MOtherBCBS
NC07-07548OtherUNITED HEALTHCARE
NC89-0297MMedicaid
NC89-0297MMedicaid
NCG07022Medicare UPIN