Provider Demographics
NPI:1689677742
Name:GOLDBLATT, WARREN (MD)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:
Last Name:GOLDBLATT
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 1:155 BORTHWICK AVE
Mailing Address - Street 2:SUITE 200 EAST
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7156
Mailing Address - Country:US
Mailing Address - Phone:603-436-1773
Mailing Address - Fax:603-427-0655
Practice Address - Street 1:155 BORTHWICK AVE
Practice Address - Street 2:SUITE 200 EAST
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-7156
Practice Address - Country:US
Practice Address - Phone:603-436-1773
Practice Address - Fax:603-427-0655
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH9482174400000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3076501Medicaid
NHRE3750Medicare ID - Type Unspecified
F33018Medicare UPIN