Provider Demographics
NPI:1609832104
Name:BLACKSMITH, JAMES EDWARD (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:BLACKSMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:946 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:LEMOYNE
Mailing Address - State:PA
Mailing Address - Zip Code:17043-1406
Mailing Address - Country:US
Mailing Address - Phone:717-761-2066
Mailing Address - Fax:717-418-2389
Practice Address - Street 1:689 YORKTOWN RD
Practice Address - Street 2:
Practice Address - City:LEWISBERRY
Practice Address - State:PA
Practice Address - Zip Code:17339-9258
Practice Address - Country:US
Practice Address - Phone:717-932-4050
Practice Address - Fax:717-932-8072
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-24
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS002954L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006117040007Medicaid
PA126441F6KOtherMEDICARE PTAN