Provider Demographics
NPI:1215099833
Name:BLACKMAN, GURVAN E (MD)
Entity type:Individual
Prefix:
First Name:GURVAN
Middle Name:E
Last Name:BLACKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3625 QUAKERBRIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619
Mailing Address - Country:US
Mailing Address - Phone:609-689-1600
Mailing Address - Fax:
Practice Address - Street 1:2501 KUSER RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08691
Practice Address - Country:US
Practice Address - Phone:609-585-8800
Practice Address - Fax:609-585-1825
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4394562085R0202X, 2085R0204X
NJ25MA087308002085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102448287Medicaid
NJ0227579Medicaid
PA102448287Medicaid
PA178102Medicare PIN