Provider Demographics
NPI:1093768129
Name:BLAIS, VALERIE (MT)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:BLAIS
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 SAINT JOHN ST
Mailing Address - Street 2:SUITE 132
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3000
Mailing Address - Country:US
Mailing Address - Phone:207-773-1215
Mailing Address - Fax:207-773-1215
Practice Address - Street 1:222 SAINT JOHN ST
Practice Address - Street 2:SUITE 132
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3000
Practice Address - Country:US
Practice Address - Phone:207-773-1215
Practice Address - Fax:207-773-1215
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT342174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME048124OtherANTHEM BLUE CROSS BLUE SH