Provider Demographics
NPI:1770016016
Name:ROSENBLATT, LUCAS JACOB (MD)
Entity Type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:JACOB
Last Name:ROSENBLATT
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 22421
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29413-2421
Mailing Address - Country:US
Mailing Address - Phone:844-999-9970
Mailing Address - Fax:843-989-0020
Practice Address - Street 1:46 MONTAGU ST APT B
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-6709
Practice Address - Country:US
Practice Address - Phone:844-999-9970
Practice Address - Fax:843-589-1264
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC48142084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program