Provider Demographics
NPI:1598827792
Name:BLIDNER, MARTIN D (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:D
Last Name:BLIDNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:610 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-3702
Mailing Address - Country:US
Mailing Address - Phone:570-288-5441
Mailing Address - Fax:570-288-5842
Practice Address - Street 1:150 MUNDY STREET
Practice Address - Street 2:MAC II BLDG
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702
Practice Address - Country:US
Practice Address - Phone:570-824-7117
Practice Address - Fax:570-825-7610
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038941L207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0042762000OtherINDEPENDENCE BS
PA0802107Medicaid
PA802060OtherFIRST PRIORITY
B37417Medicare UPIN
PA126723L3FMedicare Oscar/Certification