Individual
DR. JERRY MAX BLAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
LAHEY CLINIC- GENERAL INTERNAL MEDICINE, 41 MALL ROAD, BURLINGTON, MA 01805-0001
(781) 744-7000
(781) 744-5349
Mailing address
LAHEY CLINIC, 41 MALL ROAD, BURLINGTON, MA 01805-0001
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
36488
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110063814A
—
MA
Enumeration date
09/02/2006
Last updated
10/27/2010
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