Provider Demographics
NPI:1205845542
Name:BLAUSTEIN, MEL (MD,)
Entity Type:Individual
Prefix:DR
First Name:MEL
Middle Name:
Last Name:BLAUSTEIN
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:DR
Other - First Name:MEL
Other - Middle Name:
Other - Last Name:BLAUSTEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1199 BUSH ST STE 420
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-5975
Mailing Address - Country:US
Mailing Address - Phone:415-928-6100
Mailing Address - Fax:415-928-6102
Practice Address - Street 1:1199 BUSH ST
Practice Address - Street 2:SUITE 420
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5999
Practice Address - Country:US
Practice Address - Phone:415-928-6100
Practice Address - Fax:415-928-6102
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G2305702084A0401X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G230570Medicare ID - Type Unspecified
CAA41828Medicare UPIN