Provider Demographics
NPI:1538117908
Name:BLACKMAN, JEFFREY D (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:D
Last Name:BLACKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:402 LIPPINCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4112
Mailing Address - Country:US
Mailing Address - Phone:856-782-3300
Mailing Address - Fax:856-504-8029
Practice Address - Street 1:525 ROUTE 73 S
Practice Address - Street 2:EVESHAM COMMONS 102
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-9642
Practice Address - Country:US
Practice Address - Phone:856-596-3434
Practice Address - Fax:856-596-9110
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA05725800208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
077356Medicare PIN