Healthcare Provider Details

I. General information

NPI: 1013208198
Provider Name (Legal Business Name): AARON DAVID GREENBLATT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2011
Last Update Date: 09/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W PRATT ST
BALTIMORE MD
21223-2679
US

IV. Provider business mailing address

110 S PACA ST 4TH FLOOR
BALTIMORE MD
21201-1642
US

V. Phone/Fax

Practice location:
  • Phone: 443-462-3420
  • Fax:
Mailing address:
  • Phone: 443-462-3420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0077774
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberD0077774
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: