Provider Demographics
NPI:1730165911
Name:BLATT, ELLEN R (MD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:R
Last Name:BLATT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 E GEDDES AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3800
Mailing Address - Country:US
Mailing Address - Phone:303-761-9190
Mailing Address - Fax:303-761-6278
Practice Address - Street 1:10101 RIDGEGATE PKWY
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5522
Practice Address - Country:US
Practice Address - Phone:303-761-9190
Practice Address - Fax:303-761-6278
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO434922085R0202X
NE249762085R0202X
KS04-363462085R0202X
HIMD175822085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1730165911Medicaid
SD1730165911Medicaid
ID1730165911Medicaid
NM41502086Medicaid
CO61322318Medicaid
NE84059792913Medicaid
CAXPY203692Medicaid
NE10025709000Medicaid
MI1730165911Medicaid
TN1530354Medicaid
UT1730165911Medicaid
WY121622800Medicaid
MT1730165911Medicaid
AL177858Medicaid
MO200096808Medicaid
AZ177858Medicaid
KS200332770AMedicaid
LA2193139Medicaid
LA2193139Medicaid
NENA1215002Medicare PIN
UT1730165911Medicaid
CO802038Medicare PIN
NEP00720350Medicare PIN
NENA1214002Medicare PIN
MT1730165911Medicaid
MO200096808Medicaid
NE84059792913Medicaid
KS111257040Medicare PIN
CO394478ZLJ3Medicare PIN
WY121622800Medicaid
NE10025709000Medicaid
KSKA3249022Medicare PIN
NENA2517023Medicare PIN