Provider Demographics
NPI:1275792038
Name:BLACKMAN, RYAN GRAHAM (DO)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:GRAHAM
Last Name:BLACKMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:FRONT ST AND ERIE AVE
Mailing Address - Street 2:ST CHRISTOPHERS HOSPITAL FOR CHILDREN
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134
Mailing Address - Country:US
Mailing Address - Phone:215-427-5000
Mailing Address - Fax:
Practice Address - Street 1:9501 ROOSEVELT BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1025
Practice Address - Country:US
Practice Address - Phone:215-969-4917
Practice Address - Fax:215-969-5875
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOT012097208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics