Provider Demographics
NPI:1629428644
Name:BLAIR, WILLIAM R (DO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:BLAIR
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:200 MILL RD STE 180
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5255
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:479 SWANSEA MALL DR
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777-4119
Practice Address - Country:US
Practice Address - Phone:508-973-1570
Practice Address - Fax:508-973-1545
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2020-04-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
RIDO00962207Q00000X
MA279139207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIRES000Medicare UPIN