1992024418 NPI number — MR. ROBERT KEITH BLACKWOOD JR. R.PH.

Table of content: MR. ROBERT KEITH BLACKWOOD JR. R.PH. (NPI 1992024418)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992024418 NPI number — MR. ROBERT KEITH BLACKWOOD JR. R.PH.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLACKWOOD
Provider First Name:
ROBERT
Provider Middle Name:
KEITH
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
R.PH.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992024418
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
348 WINCHESTER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KEENE
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03431-3936
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-352-6969
Provider Business Mailing Address Fax Number:
603-352-7936

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
348 WINCHESTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KEENE
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03431-3936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-352-6969
Provider Business Practice Location Address Fax Number:
603-352-7936
Provider Enumeration Date:
05/24/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  R823 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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