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NPI Code Detail

MEDICARE: GARY BLAIR

MEDICARE: GARY BLAIR
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
1207P00000XEmergency Medicine Physician79479MA

Other Identifiers

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

General Provider Information

NPI Number : 1962498378
Entity Type Code : Individual
Provider Name (Legal Business Name) : GARY BLAIR
Provider Business Mailing Address
First Line : 163 GORE ST
Second Line :
City : CAMBRIDGE
State : MA
Zip : 02141-1131
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 103 GARLAND ST
Second Line :
City : EVERETT
State : MA
Zip : 02149-5066
Country : US
Telephone Number : 617-665-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2005
Last Update Date : 06/25/2012

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Directions to “ GARY BLAIR ” Practice Location

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