Provider Demographics
NPI:1346230422
Name:BLATT, MICHAEL W (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:BLATT
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 1:106 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-6700
Mailing Address - Country:US
Mailing Address - Phone:740-695-5207
Mailing Address - Fax:740-695-4116
Practice Address - Street 1:106 PLAZA DR
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-6700
Practice Address - Country:US
Practice Address - Phone:740-695-5207
Practice Address - Fax:740-695-4116
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12278207RP1001X
OH35046680207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0434613Medicaid
WV0083278000Medicaid
OH0434613Medicaid
WV0477976Medicare PIN
OH0477977Medicare PIN
WVB4258Medicare UPIN
WVWV5548AMedicare PIN