Provider Demographics
NPI:1316276181
Name:BLACKMAN, JEROME SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:JEROME
Middle Name:SCOTT
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 1:101 N LYNNHAVEN RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7523
Mailing Address - Country:US
Mailing Address - Phone:757-463-3000
Mailing Address - Fax:757-431-2023
Practice Address - Street 1:101 N LYNNHAVEN RD
Practice Address - Street 2:SUITE 204
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7523
Practice Address - Country:US
Practice Address - Phone:757-463-3000
Practice Address - Fax:757-431-2023
Is Sole Proprietor?:No
Enumeration Date:2009-12-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010403582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VABB0860684OtherDEA REG. NUMBER