Healthcare Provider Details

I. General information

NPI: 1013969765
Provider Name (Legal Business Name): SETH D BLANK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 12/07/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 STATE ST THIRD FLOOR
PORTLAND ME
04101-3776
US

IV. Provider business mailing address

144 STATE ST THIRD FLOOR
PORTLAND ME
04101-3776
US

V. Phone/Fax

Practice location:
  • Phone: 207-879-3120
  • Fax: 207-879-3127
Mailing address:
  • Phone: 207-879-3120
  • Fax: 207-879-3127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMD13305
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: