Provider Demographics
NPI:1477507994
Name:WILLIAM S BLAKEMORE MD LTD
Entity type:Organization
Organization Name:WILLIAM S BLAKEMORE MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CORP.
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:BLAKEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-482-7471
Mailing Address - Street 1:101 MARK DR
Mailing Address - Street 2:
Mailing Address - City:EDENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27932-1704
Mailing Address - Country:US
Mailing Address - Phone:252-482-7471
Mailing Address - Fax:252-482-5465
Practice Address - Street 1:101 MARK DR
Practice Address - Street 2:
Practice Address - City:EDENTON
Practice Address - State:NC
Practice Address - Zip Code:27932-1704
Practice Address - Country:US
Practice Address - Phone:252-482-7471
Practice Address - Fax:252-482-5465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24730207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890131VMedicaid
NC0131VOtherBLUE CROSS GROUP NUMBER
NCCG5520OtherRAILROAD MEDICARE
NC0649360001Medicare NSC
NC890131VMedicaid