Provider Demographics
NPI:1598727570
Name:BLAINE, GERMAINE M (MD)
Entity Type:Individual
Prefix:DR
First Name:GERMAINE
Middle Name:M
Last Name:BLAINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 W NEW HAVEN AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-4110
Mailing Address - Country:US
Mailing Address - Phone:321-434-1744
Mailing Address - Fax:321-952-0382
Practice Address - Street 1:1130 HICKORY ST STE B
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901
Practice Address - Country:US
Practice Address - Phone:321-361-5602
Practice Address - Fax:321-952-6179
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78051207RH0000X, 207RX0202X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261306900Medicaid
FL58954QOtherMEDICARE
FL58954TMedicare PIN
FL58954VMedicare PIN
H42864Medicare UPIN