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General NPI Number Information
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NPI Number | 1619030103
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Entity Type | Individual
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Provider Name | KENNETH S BLATT MD
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Gender | Male
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 04/14/2022
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Provider Practice Location Address
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Address Line | 30 ALPINE PLACE DRIVE APARTMENT 112
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City | NORTH CONWAY
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State | NH
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Zip | 03860-1064
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Country | US
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Telephone | 860-478-8354
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1064
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City | NORTH CONWAY
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State | NH
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Zip | 03860-1064
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Country | US
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Telephone | 860-478-8354
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Fax |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 018051
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 22142
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License Number State | NH
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