Healthcare Provider Details

I. General information

NPI: 1780926501
Provider Name (Legal Business Name): KATHERINE DIRENZO BLATT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 REED AVE
WYOMISSING PA
19610-2029
US

IV. Provider business mailing address

PO BOX 825624
PHILADELPHIA PA
19182-5624
US

V. Phone/Fax

Practice location:
  • Phone: 610-898-7040
  • Fax: 610-376-8239
Mailing address:
  • Phone: 484-628-5820
  • Fax: 484-628-5056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number125.062659
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301112379
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD471202
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: