Individual
DR. THEODORE BLAINE
Active
Individual
DR. THEODORE BLAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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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