Provider Demographics
NPI:1538155494
Name:BLAINE, JAMES A (DPM)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:BLAINE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 TECHNOLOGY DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-1801
Mailing Address - Country:US
Mailing Address - Phone:724-482-4192
Mailing Address - Fax:724-482-4859
Practice Address - Street 1:104 TECHNOLOGY DR
Practice Address - Street 2:SUITE 103
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-1801
Practice Address - Country:US
Practice Address - Phone:724-482-4192
Practice Address - Fax:724-482-4859
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001648L213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1538155494OtherNPI
PA001468255Medicaid
PA001468255Medicaid
PA066450Medicare ID - Type Unspecified