Provider Demographics
NPI:1720321565
Name:BLEVINS, DEREK MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:MARTIN
Last Name:BLEVINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:110 E 60TH ST RM 900
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1697
Mailing Address - Country:US
Mailing Address - Phone:914-340-4535
Mailing Address - Fax:385-355-2734
Practice Address - Street 1:110 E 60TH ST RM 900
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1697
Practice Address - Country:US
Practice Address - Phone:914-340-4535
Practice Address - Fax:385-355-2734
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-29
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2883182084P0802X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry