Provider Demographics
NPI:1467465450
Name:BLACKLOCK, CURT D (DO)
Entity Type:Individual
Prefix:
First Name:CURT
Middle Name:D
Last Name:BLACKLOCK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 GLASGOW AVE
Mailing Address - Street 2:STE 218
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-5704
Mailing Address - Country:US
Mailing Address - Phone:302-392-2337
Mailing Address - Fax:302-392-2333
Practice Address - Street 1:2600 GLASGOW AVE
Practice Address - Street 2:STE 218
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5704
Practice Address - Country:US
Practice Address - Phone:302-392-2337
Practice Address - Fax:302-392-2333
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC20003134207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE239903Medicaid
DEDO0167OtherDCS
DEBB1598436OtherDEA
DE006798G52Medicare ID - Type Unspecified
E36826Medicare UPIN