# THEODORE A BLAINE MD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457261711
- **Authorized official:** THEODORE BLAINE MD (OWNER/PHYSICIAN)
- **Authorized official phone:** (203) 705-0766

## Contact information

- **Practice address:** 1 BLACHLEY RD, STAMFORD, CT 06902-0002
- **Practice address phone:** (203) 705-0766
- **Mailing address:** PO BOX 12113, HAUPPAUGE, NY 11788-0833
- **Mailing address phone:** (203) 705-0766

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 207XX0005X | Sports Medicine (Orthopaedic Surgery) Physician | — | NULL | — |
| 207XX0005X | Sports Medicine (Orthopaedic Surgery) Physician | — | — | — |

## Other

- **Enumeration date:** 09/09/2026
- **Last updated:** 09/09/2026