Individual
DR. JACK D BLAINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4400 E WEST HWY, SUITE 225, BETHESDA, MD 20814-4524
(301) 983-4493
(301) 983-9379
Mailing address
10821 LARKMEADE LN, POTOMAC, MD 20854-2704
(301) 983-4493
(301) 983-9379
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
D0004502
MD
Other
Enumeration date
01/14/2007
Last updated
07/08/2007
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