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General NPI Number Information
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NPI Number | 1508395450
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Entity Type | Individual
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Provider Name | ANDREA CHRISTINE BLAINE PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/05/2017
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Last Update Date | 03/18/2022
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Provider Practice Location Address
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Address Line | 4940 EASTERN AVE
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City | BALTIMORE
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State | MD
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Zip | 21224-2735
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Country | US
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Telephone | 330-201-6797
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Fax |
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Provider Business Mailing Address
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Address Line | 2700 QUARRY LAKE DR STE 360
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City | BALTIMORE
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State | MD
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Zip | 21209-3746
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Country | US
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Telephone | 410-601-4417
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Fax | 410-601-7138
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C0006458
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License Number State | MD
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