Provider Demographics
NPI:1245821560
Name:GREENBLATT, NOAH AARON KELLY (PA-C)
Entity type:Individual
Prefix:MR
First Name:NOAH
Middle Name:AARON KELLY
Last Name:GREENBLATT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:305 IVY ARBOR WAY
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-4811
Mailing Address - Country:US
Mailing Address - Phone:919-710-2922
Mailing Address - Fax:
Practice Address - Street 1:2509 STEWART ST
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-5146
Practice Address - Country:US
Practice Address - Phone:919-710-2922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-10903363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant