Provider Demographics
NPI:1194728519
Name:BLATT, JEFFREY (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:BLATT
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 1:1 W ELM ST
Mailing Address - Street 2:STE 100
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2007
Mailing Address - Country:US
Mailing Address - Phone:610-567-6967
Mailing Address - Fax:610-567-6170
Practice Address - Street 1:790 PENLLYN BLUE BELL PIKE
Practice Address - Street 2:STE 101
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-1657
Practice Address - Country:US
Practice Address - Phone:215-542-9700
Practice Address - Fax:215-542-9756
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2010-07-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD013386E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007869340011Medicaid
PA0007869340011Medicaid
PA104042QYRMedicare PIN
PA160058158Medicare PIN