Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 0103000665 | VA |
NPI | 1083617260 |
---|---|
Provider Name | Dr. Marc Blatstein |
First Address | Fredericksburg, VA 22401-4923 |
Second Address | Fredericksburg, VA 22401-4923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U00649 | (02) | VA |