1730165911 NPI number — DR. ELLEN R BLATT M.D.

Table of content: DR. ELLEN R BLATT M.D. (NPI 1730165911)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730165911 NPI number — DR. ELLEN R BLATT M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLATT
Provider First Name:
ELLEN
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730165911
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10700 E GEDDES AVE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
ENGLEWOOD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80112-3800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-761-9190
Provider Business Mailing Address Fax Number:
303-761-6278

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10101 RIDGEGATE PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONE TREE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80124-5522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-761-9190
Provider Business Practice Location Address Fax Number:
303-761-6278
Provider Enumeration Date:
12/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  43492 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0202X , with the licence number: 24976 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 04-36346 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: MD17582 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1730165911 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1730165911 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1730165911 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 41502086 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 61322318 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 84059792913 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: XPY203692 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10025709000 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1730165911 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1530354 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1730165911 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 121622800 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1730165911 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 177858 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200096808 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 177858 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200332770A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2193139 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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