Stephen Clyde Blair, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

C0000846 Issued in MD

Practice address

9901 Medical Center Dr
Rockville, MD 20850-3357

Phone

(240) 826-7072

Fax

(240) 826-7040

NPI assigned

Sep 14, 2009

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Grundy Center Medical Facility LLC

  • Durable Medical Equipment & Medical Supplies
  • Delray Beach, FL
  • NPI 1508799511
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1252886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1252886400000",
    "number": "1205169976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ADVENTIST PHYSICIAN SERVICES INC",
            "address_2": "P.O. BOX 64742",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212640001",
            "telephone_number": "301-315-3171",
            "fax_number": "240-826-7040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9901 MEDICAL CENTER DR",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208503357",
            "telephone_number": "240-826-7072",
            "fax_number": "240-826-7040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAIR",
        "first_name": "STEPHEN",
        "middle_name": "CLYDE",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-09-14",
        "last_updated": "2009-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MD",
            "license": "C0000846",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Merlique Blackwood
• Patricia Blaes
• Peter Viggo Blaes, MD
• Crystal Blair-Robinson
• Amanda Blair
• Stephonia Blaisdell
• Karema Blake
• Katherine J Blake, PHD
• Shykera Blake
• Timerra Blake

• Surgical Physician Assistant in Rockville, MD
• Providers in Rockville, MD by specialty
• Surgical Physician Assistant in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.