Provider Demographics
NPI:1033145834
Name:GOLDBLATT, EDWARD L (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:L
Last Name:GOLDBLATT
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 1:5000 SOUTHLAKE PARK
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-3265
Mailing Address - Country:US
Mailing Address - Phone:205-982-2500
Mailing Address - Fax:205-982-2574
Practice Address - Street 1:5000 SOUTHLAKE PARK
Practice Address - Street 2:SUITE 2250
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244-3265
Practice Address - Country:US
Practice Address - Phone:205-982-2500
Practice Address - Fax:205-982-2574
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5717208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009933335Medicaid
AL2643487OtherCIGNA
ALC76681OtherHEALTHSPRING
AL0004080329OtherAETNA
AL51516976OtherBLUE CROSS OF ALABAMA
AL51516976OtherBLUE CROSS OF ALABAMA
ALC76681Medicare UPIN