Healthcare Provider Details

I. General information

NPI: 1043284300
Provider Name (Legal Business Name): BLAINE A TUFT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 PINE ST 1ST MED GROUP/SGHC
LANGLEY AFB VA
23665-2025
US

IV. Provider business mailing address

1604 WESTERLY CT
CHESAPEAKE VA
23322-1285
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-2983
  • Fax: 757-953-0868
Mailing address:
  • Phone: 757-963-0045
  • Fax: 757-953-0868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberO-191
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: