Provider Demographics
NPI:1003815044
Name:BLAIR, A HATTON (MD)
Entity Type:Individual
Prefix:
First Name:A
Middle Name:HATTON
Last Name:BLAIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 HOWELL RD
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-9518
Mailing Address - Country:US
Mailing Address - Phone:610-651-2713
Mailing Address - Fax:651-651-2713
Practice Address - Street 1:2140 HOWELL RD
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-9518
Practice Address - Country:US
Practice Address - Phone:610-651-2713
Practice Address - Fax:651-651-2713
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD432607207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126457406Medicaid
8510M0OtherBCBS OF TX PROVIDER #
TX126457406Medicaid
8510M0OtherBCBS OF TX PROVIDER #