Provider Demographics
NPI:1992730311
Name:BLAIR, STEPHEN JOSEPH (DO)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JOSEPH
Last Name:BLAIR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 SOUTHBOROUGH DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-3249
Mailing Address - Country:US
Mailing Address - Phone:207-761-1100
Mailing Address - Fax:207-761-3700
Practice Address - Street 1:400 SOUTHBOROUGH DR
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-3249
Practice Address - Country:US
Practice Address - Phone:207-761-1100
Practice Address - Fax:207-761-3700
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1236207Q00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME00318823Medicaid
ME00318823Medicaid