Basic Information
| Provider Information | |||||||||
| NPI: | 1730144742 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLATT | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | PATRICK | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 636799 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452636799 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135696422 | ||||||||
| FaxNumber: | 5135695199 | ||||||||
| Practice Location | |||||||||
| Address1: | 330 STRAIGHT STREET | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452191069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136240934 | ||||||||
| FaxNumber: | 5136240999 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2006 | ||||||||
| LastUpdateDate: | 08/07/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | OH3556734 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | OH3556734 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 207RI0200X | 3556734 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | 1013066281 | 01 | OH | NPI GROUP | OTHER | 0116832 | 05 | OH | MEDICAID | IN9310411 | 01 | OH | MEDICRE GROUP | OTHER |