Provider Demographics
NPI:1821792672
Name:RITTER BLEVINS, MALLORY RENEE (MD)
Entity Type:Individual
Prefix:DR
First Name:MALLORY
Middle Name:RENEE
Last Name:RITTER BLEVINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MALLORY
Other - Middle Name:RENEE
Other - Last Name:RITTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:800 ROSE ST RM C-368
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0293
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 ROSE ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-7001
Practice Address - Country:US
Practice Address - Phone:859-257-8801
Practice Address - Fax:859-257-2828
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program