DR. JACK D BLAINE (NPI# 1720139199) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720139199 |
| Entity Type | Individual |
| Full Name | DR. JACK D BLAINE |
| Credential | M.D. |
| Practice Address |
4400 E West Hwy Suite 225 Bethesda MD 20814-4524 |
| Mailing Address |
10821 Larkmeade Ln Potomac MD 20854-2704 |
| Practice Telephone | 3019834493 |
| Practice Fax Number | 3019839379 |
| Mailing Telephone | 3019834493 |
| Mailing Fax Number | 3019839379 |
| Enumeration Date | 2007-01-14 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
D0004502 | MD | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811999642 | Jack Colt Blaine | Nurse Anesthetist, Certified Registered | 1788 Zafiro Ct, Palm Springs, CA 92264-6808 | 2005-08-11 |
| Street Address |
4400 E WEST HWY SUITE 225 |
| City | BETHESDA |
| State | MD |
| Zip Code | 20814-4524 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548254386 | Robin Ray Mustain | Social Worker | 4400 E West Hwy, Suite 720, Bethesda, MD 20814-4524 | 2005-09-08 |
| 1285104836 | Vanessa Jan Freeman | Social Worker | 4400 E West Hwy, Ste 28, Bethesda, MD 20814-4501 | 2018-11-27 |
| 1760930473 | Lisa Genser, Lcsw-c | Social Worker | 4400 E West Hwy, Suite 26, Bethesda, MD 20814-4524 | 2016-09-12 |
| 1033664669 | Alison Carelli | Social Worker | 4400 E West Hwy, Suite 907, Bethesda, MD 20814-4524 | 2016-08-24 |
| 1053789974 | Robin Hoffland Mansfield | Social Worker | 4400 E West Hwy, Suite 907, Bethesda, MD 20814-4524 | 2015-09-09 |
| 1720368590 | Leonard Joel Guedalia | Psychologist | 4400 E West Hwy, Suite 712, Bethesda, MD 20814-4524 | 2011-08-24 |
| 1023396397 | King Therapeutic and Assessment Services | Community/Behavioral Health | 4400 E West Hwy, Bethesda, MD 20814-4524 | 2011-08-03 |
| 1164726980 | Goli Bellinger | Social Worker | 4400 E West Hwy, Suite 28, Bethesda, MD 20814-4524 | 2011-01-08 |
| 1609196906 | National Institute of Relationship Enhancement | Social Worker | 4400 E West Hwy, Suite 28, Bethesda, MD 20814-4524 | 2010-06-09 |
| 1881916351 | Henry B King Jr. | Social Worker | 4400 E West Hwy, Suite 26, Bethesda, MD 20814-4524 | 2010-02-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598365082 | Chibuzor Susan Igolo | Nurse Practitioner | 4494 N Palmer Rd N, Bethesda, MD 20814 | 2020-10-26 |
| 1922611797 | David Yardeni | Student in an Organized Health Care Education/Training Program | 10 Center Drive, 4-5722, Bethesda, MD 20814 | 2020-08-31 |
| 1003436619 | Global Psychotherapy Center of Bethesda | Community/Behavioral Health | 4400 East West Highway Suite C-e, Bethesda, MD 20814 | 2020-04-23 |
| 1306465737 | Jamie Marie Lewis | Nurse Practitioner | 104 Wood Drive, Bethesda, MD 20814 | 2020-04-15 |
| 1427687003 | Jon Lindefjeld | Student in an Organized Health Care Education/Training Program | Walter Reed National Military Medical Center Psychiatry, Bethesda, MD 20814 | 2020-04-06 |
| 1568002814 | Paige Lewis | Counselor | 7201 Wisconsin Ave. Suite 700, Bethesda, MD 20814 | 2020-01-14 |
| 1023657400 | Brightview Bethesda Grosvenor, LLC | Alzheimer Center (Dementia Center) | 5510 Grosvenor Lane, Bethesda, MD 20814 | 2020-01-02 |
| 1972144939 | Uzma Knouss | Marriage & Family Therapist | 4905 Del Ray Ave, Suite 508, Bethesda, MD 20814 | 2019-10-01 |
| 1962057620 | Catherine Jeffries | Speech-Language Pathologist | 7921 Lynnbrook Drive, Bethesda, MD 20814 | 2019-08-08 |
| 1992368963 | Sheryl Lynne Winans | Occupational Therapist | 8001 Lynbrook Drive, Bethesda, MD 20814 | 2019-04-16 |
| Find all providers in zip 20814 | ||||
| Taxonomy Code | 2084P0800X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Psychiatry |
| A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154949402 | Wallace Philip Shaw | Psychiatry & Neurology | Clinical Center Nih, Bethesda, MD 20892-0001 | 2020-07-13 |
| 1588193502 | Nicola Sater Md LLC | Psychiatry & Neurology | 5413 W Cedar Ln Ste 206c, Bethesda, MD 20814-1520 | 2017-06-05 |
| 1548716277 | Roberta Glass | Psychiatry & Neurology | 9806 Marquette Dr., Bethesda, MD 20817 | 2016-09-01 |
| 1528453537 | Nicole Renee Smith | Psychiatry & Neurology | Bg 10 Rm 3c113 Msc 1379 10 Center Dr, Bethesda, MD 20892-0001 | 2015-04-06 |
| 1326448721 | Deborah Dauphinais, M.d.,p.c. | Psychiatry & Neurology | 7910 Woodmont Ave Ste 305b, Bethesda, MD 20814-3002 | 2014-09-04 |
| 1801209887 | Layan Zhang | Psychiatry & Neurology | 4857 Battery Ln, Apt 208, Bethesda, MD 20814-2734 | 2014-06-06 |
| 1235553561 | Richard M Kapit | Psychiatry & Neurology | 10507 Weymouth St, #203, Bethesda, MD 20814-4260 | 2014-02-06 |
| 1578909081 | David Nesaraja Ratnavale | Psychiatry & Neurology | 6528 Lone Oak Drive, Bethesda, MD 20817 | 2013-05-13 |
| 1912341173 | Nida Muzaffar | Psychiatry & Neurology | 4350 E West Hwy, Bethesda, MD 20814-4410 | 2013-04-18 |
| 1124361134 | Edwin Fuller Torrey | Psychiatry & Neurology | 6204 Ridge Dr, Bethesda, MD 20816-2642 | 2013-03-28 |
| Find all providers in BETHESDA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.