Provider Demographics
NPI:1699824268
Name:BLACKBURN, CHARLES T (CRNA)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:T
Last Name:BLACKBURN
Suffix:
Gender:M
Credentials:CRNA
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Other - Last Name:
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Mailing Address - Street 1:2131 S 17TH ST
Mailing Address - Street 2:NEW HANOVER REG MED CENTER ANESTHESIA DEPT
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7407
Mailing Address - Country:US
Mailing Address - Phone:910-772-9202
Mailing Address - Fax:910-772-9452
Practice Address - Street 1:2131 S 17TH ST
Practice Address - Street 2:NEW HANOVER REG MED CENTER ANESTHESIA DEPT
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7407
Practice Address - Country:US
Practice Address - Phone:910-772-9202
Practice Address - Fax:910-772-9452
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2011-11-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC058057367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2618201AMedicare ID - Type Unspecified