Provider Demographics
NPI:1689877730
Name:BLODGETT, TODD (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:
Last Name:BLODGETT
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 1:401 LIBERTY AVE STE 2000
Mailing Address - Street 2:THREE GATEWAY CENTER, 20TH FLOOR
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15222-1029
Mailing Address - Country:US
Mailing Address - Phone:412-223-2272
Mailing Address - Fax:412-281-6320
Practice Address - Street 1:401 LIBERTY AVE STE 2000
Practice Address - Street 2:THREE GATEWAY CENTER, 20TH FLOOR
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15222-1029
Practice Address - Country:US
Practice Address - Phone:412-223-2272
Practice Address - Fax:412-281-6320
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4280262085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1019717330001Medicaid
PAP00810797OtherRAILROAD MEDICARE
PA1974765OtherHIGHMARK BCBS
PA113340WUHMedicare PIN