Provider Demographics
NPI:1588232318
Name:BLACKWOOD, JANESSA (CPT 2 PHLEBOTOMIST)
Entity Type:Individual
Prefix:MRS
First Name:JANESSA
Middle Name:
Last Name:BLACKWOOD
Suffix:
Gender:F
Credentials:CPT 2 PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9997 CAMPUS WAY S
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-2151
Mailing Address - Country:US
Mailing Address - Phone:240-351-9065
Mailing Address - Fax:
Practice Address - Street 1:14502 GREENVIEW DR FL 5
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-3287
Practice Address - Country:US
Practice Address - Phone:410-705-4423
Practice Address - Fax:410-457-3164
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD246R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246R00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Pathology