MEDICARE: MR. VITALY BLATNOY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2471S1302X	Sonography Radiologic Technologist	ME92940	FL
2	207N00000X	Dermatology Physician	ME92940	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669462123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VITALY BLATNOY MD

Provider Business Mailing Address
First Line	:	7560 RED BUG LAKE RD STE 1014
Second Line	:
City	:	OVIEDO
State	:	FL
Zip	:	32765-6591
Country	:	US
Telephone Number	:	407-706-1770
Fax Number	:	407-706-1777

Provider Business Practice Location Address
First Line	:	7560 RED BUG LAKE RD STE 1014
Second Line	:
City	:	OVIEDO
State	:	FL
Zip	:	32765-6591
Country	:	US
Telephone Number	:	407-706-1770
Fax Number	:	407-706-1777

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	04/25/2024

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