Provider Demographics
NPI:1952429706
Name:MICHAEL WILLIAM BLATT M D INC
Entity Type:Organization
Organization Name:MICHAEL WILLIAM BLATT M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BLATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:304-242-8050
Mailing Address - Street 1:2101 JACOB ST STE 703
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3844
Mailing Address - Country:US
Mailing Address - Phone:304-242-8050
Mailing Address - Fax:304-242-8233
Practice Address - Street 1:2101 JACOB ST STE 702
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3844
Practice Address - Country:US
Practice Address - Phone:304-242-8050
Practice Address - Fax:304-242-8233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12278207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1952429706OtherRAILROAD MEDICARE
WV1952429706OtherRAILROAD MEDICARE
WVSP02261Medicare PIN