MEDICARE: DR. DEBRA ELLEN BLAINE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	179846	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841358140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEBRA ELLEN BLAINE MD

Provider Business Mailing Address
First Line	:	46 NORTHGATE CRES
Second Line	:
City	:	MELVILLE
State	:	NY
Zip	:	11747-3028
Country	:	US
Telephone Number	:	516-822-9109
Fax Number	:

Provider Business Practice Location Address
First Line	:	558 LARKFIELD RD
Second Line	:
City	:	EAST NORTHPORT
State	:	NY
Zip	:	11731-4204
Country	:	US
Telephone Number	:	631-486-7459
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	02/24/2026

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