Provider Demographics
NPI:1669462123
Name:BLATNOY, VITALY (MD)
Entity Type:Individual
Prefix:MR
First Name:VITALY
Middle Name:
Last Name:BLATNOY
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 1:7250 RED BUG LAKE RD
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9290
Mailing Address - Country:US
Mailing Address - Phone:407-706-1770
Mailing Address - Fax:407-706-1777
Practice Address - Street 1:7250 RED BUG LAKE RD
Practice Address - Street 2:SUITE 1020
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9290
Practice Address - Country:US
Practice Address - Phone:407-706-1770
Practice Address - Fax:407-706-1777
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2018-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME929402471S1302X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001633600Medicaid
FLU5834YMedicare UPIN
I41063Medicare UPIN
U5834ZMedicare ID - Type Unspecified