Provider Demographics
NPI:1871042465
Name:BLATT, TRACY ELISA (DO)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:ELISA
Last Name:BLATT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:504 DEERFIELD CT
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-2126
Mailing Address - Country:US
Mailing Address - Phone:610-203-2053
Mailing Address - Fax:
Practice Address - Street 1:8080 OLD YORK RD STE 224
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1421
Practice Address - Country:US
Practice Address - Phone:267-626-2018
Practice Address - Fax:267-636-5205
Is Sole Proprietor?:No
Enumeration Date:2016-09-24
Last Update Date:2019-06-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS009077L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine