Provider Demographics
NPI:1104802735
Name:BLAIR, BRYAN PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:PAUL
Last Name:BLAIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2700 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:PURCHASE
Mailing Address - State:NY
Mailing Address - Zip Code:10577-2547
Mailing Address - Country:US
Mailing Address - Phone:914-607-5730
Mailing Address - Fax:914-457-1195
Practice Address - Street 1:210 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-2901
Practice Address - Country:US
Practice Address - Phone:914-682-6470
Practice Address - Fax:914-681-5245
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT043121208800000X
NY235484208800000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4C8926OtherHEALTH NET
NY1099112OtherGHIPPO
NY235484OtherCONNECTICARE
NY235484OtherHIP
NY133884168OtherMULTIPLAN
NY1785846OtherCIGNA SPECIALTY
NYP3599637OtherOXFORD
NY133884168OtherPOMCO
NY000000088488OtherGHI HMO
NY133884168OtherEMPIRE STATE PLAN (NYS)
NY133884168OtherPHCS
NY2527752OtherUNITED HEALTH CARE
NY39R431OtherBLUE CROSS ALL PLANS
NY7786694OtherAETNA NON HMO
NY133884168OtherBEECH STREET
NY133884168Medicaid
NY3918982OtherAETNA HMO SPECIALTY CARE
NY235484OtherHIP
NY133884168OtherEMPIRE STATE PLAN (NYS)
NY1785846OtherCIGNA SPECIALTY