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General NPI Number Information
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NPI Number | 1457261711
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Entity Type | Organization
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Legal Business Name | THEODORE A BLAINE MD PC
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Dates
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Enumeration Date | 09/09/2026
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Last Update Date | 09/09/2026
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Provider Practice Location Address
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Address Line | 1 BLACHLEY RD
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City | STAMFORD
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State | CT
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Zip | 06902-0002
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Country | US
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Telephone | 203-705-0766
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 12113
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City | HAUPPAUGE
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State | NY
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Zip | 11788-0833
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Country | US
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Telephone | 203-705-0766
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | THEODORE BLAINE
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Credential | MD
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Telephone | 203-705-0766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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