Provider Demographics
NPI:1629281852
Name:BLACKMAN, MARC ROY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:ROY
Last Name:BLACKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:50 IRVING ST NW
Mailing Address - Street 2:RESEARCH SERVICE (151)
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20422-0001
Mailing Address - Country:US
Mailing Address - Phone:202-745-8478
Mailing Address - Fax:202-518-4645
Practice Address - Street 1:50 IRVING ST NW
Practice Address - Street 2:RESEARCH SERVICE (151)
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20422-0001
Practice Address - Country:US
Practice Address - Phone:202-745-8478
Practice Address - Fax:202-518-4645
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD18146207RE0101X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No282N00000XHospitalsGeneral Acute Care Hospital