Provider Demographics
NPI:1508892167
Name:BLUTSTEIN, RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:BLUTSTEIN
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:PO BOX 244
Mailing Address - Street 2:
Mailing Address - City:ENOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17025-0244
Mailing Address - Country:US
Mailing Address - Phone:717-732-7171
Mailing Address - Fax:717-732-8872
Practice Address - Street 1:125 N ENOLA DR
Practice Address - Street 2:STE 101
Practice Address - City:ENOLA
Practice Address - State:PA
Practice Address - Zip Code:17025-2500
Practice Address - Country:US
Practice Address - Phone:717-732-7171
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-021815-E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD-021815-EOtherSTATE LICENSE
133014Medicare ID - Type UnspecifiedMEDICARE #
E63611Medicare UPIN
PA00805637004Medicare ID - Type UnspecifiedMA ID