Provider Demographics
NPI:1801472840
Name:BLAIN, CARL RUDOLPH
Entity type:Individual
Prefix:MR
First Name:CARL
Middle Name:RUDOLPH
Last Name:BLAIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CARL
Other - Middle Name:RUDOLPH
Other - Last Name:BLAIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:28 WORCESTER PL
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:MA
Mailing Address - Zip Code:02343-1085
Mailing Address - Country:US
Mailing Address - Phone:857-308-6508
Mailing Address - Fax:
Practice Address - Street 1:28 WORCESTER PL
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:MA
Practice Address - Zip Code:02343-1085
Practice Address - Country:US
Practice Address - Phone:857-308-6508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-21
Last Update Date:2021-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service