Mark N Blatt, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

022835 Issued in CT

Practice address

3175 Granada Dr
Cameron Park, CA 95682-8142

Phone

(203) 512-3152

NPI assigned

Jan 19, 2017

Last updated

Jan 19, 2017By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mark Blatt Associates, Inc

  • Primary Care Clinic/Center
  • Cameron Park, CA
  • NPI 1033654009
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1484784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484784000000",
    "number": "1992242655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3175 GRANADA DRIVE",
            "city": "CAMERON PARK",
            "state": "CA",
            "postal_code": "956828142",
            "telephone_number": "203-512-3152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3175 GRANADA DR",
            "city": "CAMERON PARK",
            "state": "CA",
            "postal_code": "956828142",
            "telephone_number": "203-512-3152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLATT",
        "first_name": "MARK",
        "middle_name": "N",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-01-19",
        "last_updated": "2017-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CT",
            "license": "022835",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONNECTICUT STATE LICENSE",
            "identifier": "022835",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Sharon Marie Booth, MSW LCSW
• Forrest Ryan Boozer, D.D.S.
• Oksana Boyechko, D.M.D.
• Brar Dental Group Inc
• Cloe Jean Brown, BS

• Family Medicine Physician in Cameron Park, CA
• Providers in Cameron Park, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.