Provider Demographics
NPI:1881798403
Name:BLITZER, ROBERT HARRY (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:HARRY
Last Name:BLITZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:AVRUM
Other - Middle Name:HARRY
Other - Last Name:BLITZER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 415933
Mailing Address - Street 2:HARTFORD HOSPITAL PROFESSIONAL SERVICES
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5933
Mailing Address - Country:US
Mailing Address - Phone:860-545-7602
Mailing Address - Fax:
Practice Address - Street 1:80 SEYMOUR STREET
Practice Address - Street 2:HARTFORD HOSPITAL GASTROENTEROLOGY DEPT
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06102-5037
Practice Address - Country:US
Practice Address - Phone:860-545-2791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT020186207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001201862Medicaid
CT001201862Medicaid
CTD400084347 - C00023Medicare PIN
CTD400084344 - C00814Medicare PIN
CT110006202Medicare ID - Type Unspecified