Provider Demographics
NPI:1295115020
Name:BLEVINS, CAROLINE
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 POCOSHOCK PL
Mailing Address - Street 2:STE 104
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-6345
Mailing Address - Country:US
Mailing Address - Phone:804-276-9305
Mailing Address - Fax:804-674-4145
Practice Address - Street 1:2500 POCOSHOCK PL
Practice Address - Street 2:STE 104
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-6345
Practice Address - Country:US
Practice Address - Phone:804-276-9305
Practice Address - Fax:804-674-4145
Is Sole Proprietor?:No
Enumeration Date:2015-06-07
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116028260207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine