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General NPI Number Information
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NPI Number | 1598727570
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Entity Type | Individual
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Provider Name | GERMAINE M BLAINE MD
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Gender | Female
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Dates
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Enumeration Date | 04/05/2006
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 1130 HICKORY ST STE B
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City | MELBOURNE
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State | FL
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Zip | 32901
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Country | US
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Telephone | 321-361-5602
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Fax | 321-952-6179
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Provider Business Mailing Address
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Address Line | 3300 S FISKE BLVD
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City | ROCKLEDGE
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State | FL
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Zip | 32955-4306
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Country | US
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Telephone | 321-361-5600
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Fax |
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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 | 207RH0000X
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Taxonomy Name | Hematology (Internal Medicine) Physician
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License Number | ME78051
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number | ME78051
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | ME78051
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License Number State | FL
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