Provider Demographics
NPI:1245229335
Name:BLAIS, DENIS J (MD)
Entity Type:Individual
Prefix:DR
First Name:DENIS
Middle Name:J
Last Name:BLAIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1622
Mailing Address - Country:US
Mailing Address - Phone:781-331-4600
Mailing Address - Fax:781-337-5095
Practice Address - Street 1:780 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1622
Practice Address - Country:US
Practice Address - Phone:781-331-4600
Practice Address - Fax:781-337-5095
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA59081174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA059081OtherTUFTS
MA0001666001OtherCIGNA
MA0011777OtherNEIGHBORHOOD HEALTH PLAN
MA1900035OtherUNITED HEALTHCARE
MA27748OtherHARVARD PILGRIM
MA34742OtherFALLON
MA4487896OtherUS HEALTHCARE
MA9718672Medicaid
MAM13172Medicare ID - Type Unspecified
MA9718672Medicaid