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Organization
THEODORE A BLAINE MD PC
Active
Organization
THEODORE A BLAINE MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THEODORE BLAINE MD (OWNER/PHYSICIAN)
(203) 705-0766
Entity
Organization
Contact information
Practice address
1 BLACHLEY RD, STAMFORD, CT 06902-0002
(203) 705-0766
Mailing address
PO BOX 12113, HAUPPAUGE, NY 11788-0833
(203) 705-0766
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
NULL
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
—
NULL
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
—
—
Other
Enumeration date
09/09/2026
Last updated
09/09/2026
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