Provider Demographics
NPI:1790704690
Name:MESSING, BLAINE E (MD)
Entity Type:Individual
Prefix:DR
First Name:BLAINE
Middle Name:E
Last Name:MESSING
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 1:28 CROSS HWY
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-2140
Mailing Address - Country:US
Mailing Address - Phone:203-505-1492
Mailing Address - Fax:203-221-0125
Practice Address - Street 1:28 CROSS HWY
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-2140
Practice Address - Country:US
Practice Address - Phone:203-505-1492
Practice Address - Fax:203-221-0125
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040857207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001408576Medicaid
CTG82061Medicare UPIN