Provider Demographics
NPI:1346233269
Name:BLATSTEIN, LEE M (DO)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:M
Last Name:BLATSTEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 MEDICAL CAMPUS DR STE 305
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-7205
Mailing Address - Country:US
Mailing Address - Phone:215-257-1050
Mailing Address - Fax:215-257-3026
Practice Address - Street 1:125 MEDICAL CAMPUS DR
Practice Address - Street 2:SUITE 305
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446
Practice Address - Country:US
Practice Address - Phone:215-361-2304
Practice Address - Fax:215-361-2389
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005542L208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010989400002Medicaid
PAE52935Medicare UPIN
PA0010989400002Medicaid