Healthcare Provider Details

I. General information

NPI: 1689608705
Provider Name (Legal Business Name): ALAN ARTHUR GOLDBLATT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24419 MILLSTREAM DR
ALDIE VA
20105-5837
US

IV. Provider business mailing address

2205 NW 40TH TER STE B
GAINESVILLE FL
32605-3500
US

V. Phone/Fax

Practice location:
  • Phone: 703-712-4874
  • Fax:
Mailing address:
  • Phone: 352-375-0332
  • Fax: 352-375-1677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberME46925
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: