Provider Demographics
NPI:1821187899
Name:BLACKADAR, CHARLES SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:SAMUEL
Last Name:BLACKADAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5802 LONDONDERRY LOOP NW
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-1197
Mailing Address - Country:US
Mailing Address - Phone:360-692-2276
Mailing Address - Fax:
Practice Address - Street 1:1 BOONE RD
Practice Address - Street 2:NAVAL HOSPITAL
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-1894
Practice Address - Country:US
Practice Address - Phone:360-475-4426
Practice Address - Fax:360-475-4344
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WA37686207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine