Provider Demographics
NPI:1609040310
Name:BLAINE, CHRISTINE MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:MARIE
Last Name:BLAINE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:110 E MAIN ST
Mailing Address - Street 2:SUITE #6
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2845
Mailing Address - Country:US
Mailing Address - Phone:631-424-3600
Mailing Address - Fax:631-424-2963
Practice Address - Street 1:110 E MAIN ST
Practice Address - Street 2:SUITE #6
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2845
Practice Address - Country:US
Practice Address - Phone:631-424-3600
Practice Address - Fax:631-424-2963
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2012-09-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMT1860942086S0122X
NY265036-12086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery