Basic Information
Provider Information
NPI: 1528020757
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BLATTNER
FirstName: WILLIAM
MiddleName: ALBERT
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 64442
Address2:  
City: BALTIMORE
State: MD
PostalCode: 212644442
CountryCode: US
TelephoneNumber: 4103285793
FaxNumber: 4103280248
Practice Location
Address1: 22 S GREENE ST
Address2:  
City: BALTIMORE
State: MD
PostalCode: 212011544
CountryCode: US
TelephoneNumber: 4103285793
FaxNumber: 4103280248
Other Information
ProviderEnumerationDate: 04/04/2006
LastUpdateDate: 11/19/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RI0200XD32677MDY Allopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease

No ID Information.


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