Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD432607 | PA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | MD432607 | PA |
NPI | 1003815044 |
---|---|
Provider Name | A Hatton Blair |
First Address | Malvern, PA 19355-9518 |
Second Address | Malvern, PA 19355-9518 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2005 |
Last Update Date | 15/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
126457406 | (05) | TX |
8510M0 | BCBS OF TX PROVIDER # (01) | |
E09055 | (02) |