Provider Demographics
NPI:1093811481
Name:BLAKE, ARTHUR F (MD)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:F
Last Name:BLAKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 MOOSEHEAD TRL STE 5
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04953-4056
Mailing Address - Country:US
Mailing Address - Phone:207-368-5189
Mailing Address - Fax:207-368-4213
Practice Address - Street 1:50 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HARRINGTON
Practice Address - State:ME
Practice Address - Zip Code:04643-3043
Practice Address - Country:US
Practice Address - Phone:207-483-4502
Practice Address - Fax:207-483-2525
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
METD081128207Q00000X
ME018331207Q00000X
CT019339207Q00000X
MEMD18331207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME433381099Medicaid
ME000890101OtherMEDICARE PTAN
CT080001394Medicare ID - Type Unspecified
ME000890101OtherMEDICARE PTAN