Provider Demographics
NPI:1871798959
Name:HONTZ, BLAIR E (DO)
Entity type:Individual
Prefix:
First Name:BLAIR
Middle Name:E
Last Name:HONTZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 WALLACE ST
Mailing Address - Street 2:UNIT #1
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-3221
Mailing Address - Country:US
Mailing Address - Phone:215-582-2182
Mailing Address - Fax:
Practice Address - Street 1:5501 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3018
Practice Address - Country:US
Practice Address - Phone:215-582-2182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA390200000X207P00000X
TXP0228207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX285256804Medicaid
TXP01012688OtherRAILROAD
TXTXB139069Medicare PIN
TXP01012688OtherRAILROAD
TXTXB139066Medicare PIN