Provider Demographics
NPI:1740240506
Name:BLEVINS, JUDITH C (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:C
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3640 HIGH ST
Mailing Address - Street 2:STE 1E
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-3213
Mailing Address - Country:US
Mailing Address - Phone:757-398-2447
Mailing Address - Fax:757-393-4522
Practice Address - Street 1:3640 HIGH ST
Practice Address - Street 2:STE 1E
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3213
Practice Address - Country:US
Practice Address - Phone:757-398-2447
Practice Address - Fax:757-393-4522
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2014-07-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA01010500332085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005825024Medicaid
VA636051Medicare ID - Type Unspecified
VA005825024Medicaid