Provider Demographics
NPI:1790895860
Name:BLATT, ANDREW N (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:N
Last Name:BLATT
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Gender:M
Credentials:MD
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Mailing Address - Street 1:675 OLD BALLAS RD
Mailing Address - Street 2:SUITE #220
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141
Mailing Address - Country:US
Mailing Address - Phone:314-997-3937
Mailing Address - Fax:314-997-3911
Practice Address - Street 1:675 OLD BALLAS RD
Practice Address - Street 2:SUITE #220
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-997-3937
Practice Address - Fax:314-997-3911
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-07-15
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Provider Licenses
StateLicense IDTaxonomies
MO103579207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO001013646Medicare PIN
MOG52911Medicare UPIN