Basic Information
Provider Information
NPI: 1417306309
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BLUTSTEIN
FirstName: REBEKAH
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1650 HUNTINGDON PIKE
Address2: SUITE 320
City: MEADOWBROOK
State: PA
PostalCode: 19046
CountryCode: US
TelephoneNumber: 2159471447
FaxNumber: 2159472603
Practice Location
Address1: 1650 HUNTINGDON PIKE STE 320
Address2:  
City: MEADOWBROOK
State: PA
PostalCode: 190468074
CountryCode: US
TelephoneNumber: 2159471447
FaxNumber: 2159472603
Other Information
ProviderEnumerationDate: 06/10/2016
LastUpdateDate: 12/08/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/08/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000XMD467509PAY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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