Individual provider · NPI-1

Dr. Charles Samuel Blackadar, M.D.

Family Medicine · Bremerton, WA

NPI number1821187899
StatusActive
Last updated in NPPESJul 8, 2007

Details

NPI
1821187899
Entity type
Individual (NPI-1)
Name
Dr. Charles Samuel Blackadar
Credential
M.D.
Sex
Male
Sole proprietor
Yes
Enumeration date
Oct 11, 2006
Last updated
Jul 8, 2007

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine37686WAYes

Practice location

1 Boone Rd
Naval Hospital
Bremerton, WA 98312-1894

Phone 360-475-4426 · Fax 360-475-4344

Mailing address

5802 Londonderry Loop Nw
Bremerton, WA 98312-1197

Phone 360-692-2276

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