Provider Demographics
NPI:1164413027
Name:BLINMAN, THANE A (MD)
Entity Type:Individual
Prefix:
First Name:THANE
Middle Name:A
Last Name:BLINMAN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:100 E PENN SQ
Mailing Address - Street 2:THE WANAMAKER BUILDING 9TH FL
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3323
Mailing Address - Country:US
Mailing Address - Phone:267-425-9538
Mailing Address - Fax:267-425-9552
Practice Address - Street 1:34TH & CIVIC CENTER BLVD
Practice Address - Street 2:CHILDREN'S HOSPITAL OF PHILADELPHIA
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4306
Practice Address - Country:US
Practice Address - Phone:215-590-2730
Practice Address - Fax:215-590-4875
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2013-03-14
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Provider Licenses
StateLicense IDTaxonomies
PAMD073948L2086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100743887-0034Medicaid
PA802044J5PMedicare PIN