Provider Demographics
NPI:1548269939
Name:BLATTER, MARK M (MD)
Entity type:Individual
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First Name:MARK
Middle Name:M
Last Name:BLATTER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:150 LANCASTER AVE
Mailing Address - Street 2:PINE BRIDGE COMMONS, STE 208
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15228-2354
Mailing Address - Country:US
Mailing Address - Phone:412-221-2121
Mailing Address - Fax:412-221-7224
Practice Address - Street 1:1580 MCLAUGHLIN RUN RD
Practice Address - Street 2:PINE BRIDGE COMMONS, STE 208
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15241
Practice Address - Country:US
Practice Address - Phone:412-221-2121
Practice Address - Fax:412-221-7224
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2016-02-20
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Provider Licenses
StateLicense IDTaxonomies
PAMD014437E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000705032000Medicaid
PA000705032000Medicaid