Basic Information
| Provider Information | |||||||||
| NPI: | 1952429706 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MICHAEL WILLIAM BLATT M D INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2101 JACOB ST STE 703 | ||||||||
| Address2: | |||||||||
| City: | WHEELING | ||||||||
| State: | WV | ||||||||
| PostalCode: | 260033844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042428050 | ||||||||
| FaxNumber: | 3042428233 | ||||||||
| Practice Location | |||||||||
| Address1: | 2101 JACOB ST STE 702 | ||||||||
| Address2: | |||||||||
| City: | WHEELING | ||||||||
| State: | WV | ||||||||
| PostalCode: | 260033844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042428050 | ||||||||
| FaxNumber: | 3042428233 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2007 | ||||||||
| LastUpdateDate: | 04/17/2015 | ||||||||
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| AuthorizedOfficialLastName: | BLATT | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | WILLIAM | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 3042428050 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | M.D., | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 12278 | WV | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 1952429706 | 01 | WV | RAILROAD MEDICARE | OTHER |