Healthcare Provider Details

I. General information

NPI: 1093811481
Provider Name (Legal Business Name): ARTHUR F. BLAKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 E MAIN ST
HARRINGTON ME
04643-3043
US

IV. Provider business mailing address

118 MOOSEHEAD TRL STE 5
NEWPORT ME
04953-4056
US

V. Phone/Fax

Practice location:
  • Phone: 207-483-4502
  • Fax: 207-483-2525
Mailing address:
  • Phone: 207-368-5189
  • Fax: 207-368-4213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberTD081128
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number018331
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number019339
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD18331
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: