Individual
MR. BLAINE HAVENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SA-C, TS-C
Contact information
Practice address
14320 W SIDE BLVD APT 303, LAUREL, MD 20707-6260
(440) 941-7716
Mailing address
14320 W SIDE BLVD APT 303, LAUREL, MD 20707-6260
(440) 941-7716
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
26-125
MD
Other
Enumeration date
02/02/2026
Last updated
02/02/2026
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