Provider Demographics
NPI:1851385769
Name:BLOTZER, JOHN WOLFE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WOLFE
Last Name:BLOTZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:J
Other - Middle Name:WOLFE
Other - Last Name:BLOTZER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:858 SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17407-1362
Mailing Address - Country:US
Mailing Address - Phone:717-428-3753
Mailing Address - Fax:
Practice Address - Street 1:858 SCHOOL RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17407-1362
Practice Address - Country:US
Practice Address - Phone:717-428-3753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD017704E207RH0002X, 207RR0500X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001012383Medicaid
PA107844OtherHIGHMARK BLUE SHIELD
PA211424OtherJOHNS HOPKINS
MD350471OtherCAREFIRST MD BCBS
PA5411249OtherAETNA
PA34580OtherGEISINGER
PA34580OtherGEISINGER
PA107844OtherHIGHMARK BLUE SHIELD
PA001012383Medicaid
PA20085445OtherAMERIHEALTH MERCY-WMG
B36724Medicare UPIN
PA107844OtherHIGHMARK BLUE SHIELD
PA239452OtherUNISON-WMG AHIM
PA1525269OtherGATEWAY-WMG
PA211424OtherJOHNS HOPKINS
PA2168092OtherMAMSI-WMG RHEUM
PA217463OtherUNISON-WMG YPC
PA270947OtherUNISON-WMG
PAP00641372Medicare PIN