Basic Information
| Provider Information | |||||||||
| NPI: | 1790965358 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLACKHAM | ||||||||
| FirstName: | AARON | ||||||||
| MiddleName: | UDELL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 783311 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191783311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4848844500 | ||||||||
| FaxNumber: | 4848840699 | ||||||||
| Practice Location | |||||||||
| Address1: | 1240 S CEDAR CREST BLVD | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181036264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104027884 | ||||||||
| FaxNumber: | 6104028875 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2007 | ||||||||
| LastUpdateDate: | 10/04/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 2010-00009 | NC | N | Allopathic & Osteopathic Physicians | Surgery | 2086X0206X | MD457822 | PA | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology |
No ID Information.