Provider Demographics
NPI:1497559348
Name:BLATTNER, CODY (PA-C)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:BLATTNER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1671 W POINT PIKE UNIT A
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-5629
Mailing Address - Country:US
Mailing Address - Phone:267-642-4883
Mailing Address - Fax:
Practice Address - Street 1:1030 E LANCASTER AVE # I1
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-1451
Practice Address - Country:US
Practice Address - Phone:484-222-6222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA066238207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine