Individual
DR. THEODORE BLAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
535 E 70TH ST, NEW YORK, NY 10021-4823
(203) 705-0766
(860) 247-3803
Mailing address
PO BOX 29234, NEW YORK, NY 10087-9234
(203) 705-0766
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
12523
RI
207X00000X
Orthopaedic Surgery Physician
196273-1
NY
207X00000X
Orthopaedic Surgery Physician
39067
CT
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
039067
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200001063
CT MEDICARE NUMBER
CT
Enumeration date
07/09/2006
Last updated
12/21/2020
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