Healthcare Provider Details

I. General information

NPI: 1386756948
Provider Name (Legal Business Name): BLAIR MITCHELL EIG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 FOREST GLEN RD
SILVER SPRING MD
20910-1483
US

IV. Provider business mailing address

12017 COLDSTREAM DR
POTOMAC MD
20854-3620
US

V. Phone/Fax

Practice location:
  • Phone: 301-754-7060
  • Fax: 301-754-7012
Mailing address:
  • Phone: 301-299-2376
  • Fax: 301-754-7012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0035053
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: