Provider Demographics
NPI:1356324735
Name:BLAUTH, JEANETTE M (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:M
Last Name:BLAUTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1020A E BOAL AVE
Mailing Address - Street 2:
Mailing Address - City:BOALSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16827-1509
Mailing Address - Country:US
Mailing Address - Phone:814-237-8627
Mailing Address - Fax:814-238-0083
Practice Address - Street 1:1240 S CEDAR CREST BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6369
Practice Address - Country:US
Practice Address - Phone:610-402-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD060676L2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA77729OtherGEISINGER HEALTH PLAN
PA133538OtherMEDPLUS/THREE RIVERS
PAP3159667OtherOXFORD
PA0867384000OtherKEYSTONE HEALTH PLAN EAST
PA0923334OtherKEYSTONE HEALTHPLAN CENTR
PA1522252OtherGATEWAY HEALTH PLAN
PA2008452OtherKEYSTONE MERCY
PA0018443620002Medicaid
PA01180101OtherCAPITAL BC
PA8748544001OtherCIGNA HMO
PA923334OtherBCBS PA
PA920006301OtherRAILROAD MEDICARE
PA20008452OtherAMERIHEALTH MERCY
PA8748544001OtherCIGNA HMO
PA0018443620002Medicaid