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General NPI Number Information
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NPI Number | 1821087537
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Entity Type | Individual
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Provider Name | MARK ROBERT GOLDBLATT DO
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Gender | Male
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Dates
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Enumeration Date | 10/14/2005
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Last Update Date | 12/14/2016
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Provider Practice Location Address
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Address Line | 30 CHOCTAW ST SUITE A
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City | ASHEVILLE
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State | NC
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Zip | 28801-4513
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Country | US
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Telephone | 828-255-7733
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Fax | 828-225-5207
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Provider Business Mailing Address
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Address Line | PO BOX 603443
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City | CHARLOTTE
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State | NC
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Zip | 28260-3443
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Country | US
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Telephone |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 737
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 737
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2010-00831
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 2010-00831
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License Number State | NC
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