Healthcare Provider Details

I. General information

NPI: 1669477139
Provider Name (Legal Business Name): PHILIP MARK BLATT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4735 OGLETOWN STANTON RD STE 2225
NEWARK DE
19713-8000
US

IV. Provider business mailing address

PO BOX 12210
WILMINGTON DE
19850-2210
US

V. Phone/Fax

Practice location:
  • Phone: 302-737-7700
  • Fax: 302-737-5407
Mailing address:
  • Phone: 302-737-7700
  • Fax: 302-737-5407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberC10002196
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: