| Doctor Name: | DR. ROBERT CHARLES BLACKWOOD |
| NPI Number: | 1407841968 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 0101051005 |
| Business Practice Address: | 1201 Lake James Dr Suite 200 Virginia Beach, VA - 234646780 |
| Business Phone Number: | 7575230022 |
| Business Fax Number: | 7575235018 |
| Mailing Address: | 1201 Lake James Dr, Suite 200 VIRGINIA BEACH |
| State: | VA |
| Postal Code: | 234646780 |
| Phone Number: | 7575230022 |
| Fax Number: | 7575235018 |
| NPI Enumeration Date: | 09/12/2005 |
| NPI Last Update Date: | 12/27/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | 03/22/2006 |
| NPI Reactivation Date: | 03/27/2006 |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 0101051005 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |