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General NPI Number Information
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NPI Number | 1164428207
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Entity Type | Individual
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Provider Name | MARK L BLITZER M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/23/2005
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Last Update Date | 07/02/2013
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Provider Practice Location Address
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Address Line | 330 ORCHARD ST. SUITE 210
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City | NEW HAVEN
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State | CT
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Zip | 06511-4429
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Country | US
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Telephone | 203-867-5400
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Fax | 203-867-5401
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Provider Business Mailing Address
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Address Line | 330 ORCHARD ST. SUITE 210
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City | NEW HAVEN
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State | CT
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Zip | 06511-4429
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Country | US
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Telephone | 203-867-5400
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Fax | 203-867-5401
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 037730
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 037730
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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