Provider Demographics
NPI:1609896711
Name:MOONBLATT, STEVEN D (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:D
Last Name:MOONBLATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8500-6335
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0001
Mailing Address - Country:US
Mailing Address - Phone:215-807-8000
Mailing Address - Fax:215-807-8235
Practice Address - Street 1:3998 RED LION RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1436
Practice Address - Country:US
Practice Address - Phone:215-612-4000
Practice Address - Fax:215-807-8235
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424884207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA452729OtherAETNA CONTRACT
PA2488640OtherCIGNA
PAP00265223OtherRAILROAD MEDICARE
PA101313156-01OtherAMERICHOICE FRANKFORD
PA1742994OtherHIGHMARK BLUE SHIELD
PA2608207OtherUNITED HEALTHCARE
PA1013131560001Medicaid
PA2408786000OtherPERSONAL CHOICE
PA101313156-03OtherAMERICHOICE TORRESDALE
PA30025562OtherKEYSTONE MERCY
PA07645OtherHEALTH PARTNERS
PA1013131560003Medicaid
PA20045154OtherAMERIHEALTH MERCY
PA2408786000OtherKEYSTONE IBC
PA101313156-02OtherAMERICHOICE BUCKS
PA1013131560002Medicaid
PA30025562OtherKEYSTONE MERCY
PA1013131560001Medicaid