Provider Demographics
NPI:1598775793
Name:BLITZER, MIRIAM (PHD)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:BLITZER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 62063
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-2063
Mailing Address - Country:US
Mailing Address - Phone:410-706-5181
Mailing Address - Fax:410-706-5103
Practice Address - Street 1:655 W BALTIMORE ST
Practice Address - Street 2:11-047
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1509
Practice Address - Country:US
Practice Address - Phone:410-328-3335
Practice Address - Fax:410-328-5484
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZG1000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGeneticist, Medical (PhD)
Provider Identifiers
StateIdentifier IDID TypeIssuer
B42700Medicare UPIN