MEDICARE: MARK D BLOSTEIN M.D.

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	207ZH0000X	Hematology (Pathology) Physician	77099	MA

General Provider Information

NPI Number	:	1730128737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK D BLOSTEIN M.D.

Provider Business Mailing Address
First Line	:	JEWISH GENERAL HOSPITAL
Second Line	:	3755 CHEMIN DE LA COTE STE CAT
City	:	MONTREAL
State	:	QC
Zip	:	H3T1E2
Country	:	CA
Telephone Number	:	514-340-8207
Fax Number	:

Provider Business Practice Location Address
First Line	:	3755 CHEMIN DE LA COTE STE CAT
Second Line	:	JEWISH GENERAL HOSPITAL
City	:	MONTREAL
State	:	QC
Zip	:	H3T1E2
Country	:	CA
Telephone Number	:	514-340-8207
Fax Number	:

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	07/08/2007

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