Provider Demographics
NPI:1730144742
Name:BLATT, STEPHEN PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:PATRICK
Last Name:BLATT
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:PO BOX 636799
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6799
Mailing Address - Country:US
Mailing Address - Phone:513-569-6422
Mailing Address - Fax:513-569-5199
Practice Address - Street 1:330 STRAIGHT STREET
Practice Address - Street 2:SUITE 400
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-1069
Practice Address - Country:US
Practice Address - Phone:513-624-0934
Practice Address - Fax:513-624-0999
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3556734207R00000X, 207RI0200X
OH3556734207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1013066281OtherNPI GROUP
OH0116832Medicaid
OHIN9310411OtherMEDICRE GROUP
OH0116832Medicaid
OHH183270Medicare PIN
OH0781292Medicare PIN
OHF97448Medicare UPIN