ROYCE BLACKWOOD (NPI# 1992286546) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992286546 |
| Entity Type | Individual |
| Full Name | ROYCE BLACKWOOD |
| Credential | PA-C |
| Practice Address |
360 Broadway Bangor ME 04401-3979 |
| Mailing Address |
C/o St Marys Health System - Provider Enrollment Po Box 7291 Lewiston ME 04243-7291 |
| Practice Telephone | 2079073650 |
| Practice Fax Number | 2079073660 |
| Mailing Telephone | 2077778560 |
| Mailing Fax Number | 2077778800 |
| Enumeration Date | 2018-08-22 |
| Last Update Date | 2019-12-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
PA1855 | ME | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
ME | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
360 BROADWAY |
| City | BANGOR |
| State | ME |
| Zip Code | 04401-3979 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154321545 | St. Joseph Hospital | General Acute Care Hospital | 360 Broadway, Bangor, ME 04401-3979 | 2005-07-28 |
| 1346802170 | Sadie Austin | Physician Assistant | 360 Broadway, Bangor, ME 04401-3900 | 2019-07-02 |
| 1386202794 | Ashley Gott Haase | Physical Therapist | 360 Broadway, Bangor, ME 04401-3979 | 2019-05-31 |
| 1609356559 | Casey Marie Northup | Pharmacy Technician | 360 Broadway, Bangor, ME 04401-3900 | 2018-08-20 |
| 1407332869 | Sara Winings | Pharmacist | 360 Broadway, Bangor, ME 04401-3979 | 2018-07-18 |
| 1811489156 | Sandra Bartlett | Pharmacist | 360 Broadway, Bangor, ME 04401-3979 | 2018-06-02 |
| 1366999534 | Eliza Sharma | Internal Medicine | 360 Broadway, Bangor, ME 04401-3900 | 2016-09-06 |
| 1871946731 | Katelyn Hopper | Anesthesiology | 360 Broadway, Bangor, ME 04401-3979 | 2016-07-15 |
| 1790139459 | Stephen Calabrese | Anesthesiology | 360 Broadway, Bangor, ME 04401-3979 | 2016-04-19 |
| 1083073480 | Jesse Knowlton | Nurse Anesthetist, Certified Registered | 360 Broadway, Bangor, ME 04401-3900 | 2016-02-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184222523 | Bj's Wholesale Club Inc. | Eyewear Supplier (Equipment, not the service) | 110 Longview Dr, Bangor, ME 04401 | 2020-10-16 |
| 1033737937 | Daniel John Phulman | Counselor | 202 Exchange Street, Bangor, ME 04401 | 2020-07-08 |
| 1770104358 | Elizabeth Sarah Caruson | Physician Assistant | 417 State Street Webber Medical Building, East St, Ste. 121, Bangor, ME 04401 | 2020-05-05 |
| 1053961300 | Erika Dean | Occupational Therapist | 84 Sylvan Rd., Bangor, ME 04401 | 2019-09-18 |
| 1942853635 | Wildworks Therapy, Pllc | Occupational Therapist | 123 Mt Hope Ave, Bangor, ME 04401 | 2019-07-22 |
| 1255999173 | Jessica Arbisi | Physician Assistant | 1 Northeast Drive, Bangor, ME 04401 | 2019-06-05 |
| 1699232041 | Ehab Khamis Elhefnawi | Anesthesiology | Emmc Anesthesia Professional Service, 489 State Street, Bangor, ME 04401 | 2019-02-21 |
| 1477028884 | Zvorufura Makura | Otolaryngology | 885 Union Street, Ste 145, Bangor, ME 04401 | 2018-10-11 |
| 1255826541 | Lindsey M Fields | Optometrist | 955 Broadway Eye Center Northeast Dba Northeast Eyecare, Bangor, ME 04401 | 2018-06-28 |
| 1992211338 | Debra J Mcintyre | Counselor | 157 Park Street, #5, Bangor, ME 04401 | 2017-12-21 |
| Find all providers in zip 04401 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679595433 | John Nowak | Physician Assistant | 489 State Street, Eastern Maine Medical Center, Bangor, ME 04401 | 2006-07-24 |
| 1093730350 | Melissa Becker | Physician Assistant | 925 Union St, Suite 3, Bangor, ME 04401-3051 | 2006-07-13 |
| 1356969521 | Ashley Gilmore | Physician Assistant | 883 Union Street, Suite 145, Bangor, ME 04401 | 2020-07-14 |
| 1508496845 | Jeremy Kent Wu | Physician Assistant | 55 Broadway Ste 2, Bangor, ME 04401-5201 | 2020-01-24 |
| 1922668466 | Kathryn Dobrovolny | Physician Assistant | 417 State St Ste 330, Bangor, ME 04401-6638 | 2019-06-17 |
| 1063076461 | Nicole Louise Robitaille | Physician Assistant | 417 State St Ste 330, Bangor, ME 04401-6638 | 2019-05-01 |
| 1356809883 | Abigail Elizabeth Bobbitt | Physician Assistant | 417 State Street, Webber West, Suite 443, Bangor, ME 04401 | 2019-03-04 |
| 1023574357 | Katherine Page Hintz | Physician Assistant | 55 Broadway Ste 2, Bangor, ME 04401-5201 | 2019-02-12 |
| 1609383041 | Alana Rive Silverman | Physician Assistant | 417 State St Ste 221, Bangor, ME 04401-6630 | 2018-01-08 |
| 1366951501 | Andrew Michael Zielinski | Physician Assistant | 417 State St Ste 340, Bangor, ME 04401-6634 | 2017-09-20 |
| Find all providers in BANGOR | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.