Provider Demographics
NPI:1730128737
Name:BLOSTEIN, MARK D (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:BLOSTEIN
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:JEWISH GENERAL HOSPITAL
Mailing Address - Street 2:3755 CHEMIN DE LA COTE STE CAT
Mailing Address - City:MONTREAL
Mailing Address - State:QC
Mailing Address - Zip Code:H3T1E2
Mailing Address - Country:CA
Mailing Address - Phone:514-340-8207
Mailing Address - Fax:
Practice Address - Street 1:3755 CHEMIN DE LA COTE STE CAT
Practice Address - Street 2:JEWISH GENERAL HOSPITAL
Practice Address - City:MONTREAL
Practice Address - State:QC
Practice Address - Zip Code:H3T1E2
Practice Address - Country:CA
Practice Address - Phone:514-340-8207
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA77099207ZH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology