Provider Demographics
NPI:1114266954
Name:BLAIS, STELLA M (PA)
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:M
Last Name:BLAIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:STELLA
Other - Middle Name:
Other - Last Name:MEUSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:6230 OLD DOBBIN LN STE 230
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-5884
Mailing Address - Country:US
Mailing Address - Phone:410-730-3399
Mailing Address - Fax:410-740-4776
Practice Address - Street 1:10120 BALTIMORE NATIONAL PIKE
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-3614
Practice Address - Country:US
Practice Address - Phone:410-730-3399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-13
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
VA363A00000X
390200000X
MDC05690363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program