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1720139199
JACK D BLAINE
BETHESDA, MD
NPI
1720139199
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
2084P0800X Psychiatry & Neurology, Psychiatry
(Licence: MD D0004502)
Enumeration Date
2007-01-14
Last Update Date
2007-07-08
Business Address
Dr. JACK D BLAINE M.D.
4400 E WEST HWY SUITE 225
BETHESDA, MD 20814-4524
Phone number: 301-983-4493
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Mailing Address
Dr. JACK D BLAINE M.D.
10821 LARKMEADE LN
POTOMAC, MD 20854-2704
Phone number: 301-983-4493
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