Provider Demographics
NPI:1851334445
Name:BLACKMAN, EDWARD L (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:L
Last Name:BLACKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1151 MALLARD MARSH DR
Mailing Address - Street 2:
Mailing Address - City:OSPREY
Mailing Address - State:FL
Mailing Address - Zip Code:34229-6810
Mailing Address - Country:US
Mailing Address - Phone:941-918-4863
Mailing Address - Fax:941-918-4863
Practice Address - Street 1:1151 MALLARD MARSH DR
Practice Address - Street 2:
Practice Address - City:OSPREY
Practice Address - State:FL
Practice Address - Zip Code:34229-6810
Practice Address - Country:US
Practice Address - Phone:941-918-4863
Practice Address - Fax:941-918-4863
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA027043208000000X
FLME96637208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics