Provider Demographics
NPI:1285696096
Name:BLINDER, MARTIN G (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:G
Last Name:BLINDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:130 MELVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-2719
Mailing Address - Country:US
Mailing Address - Phone:972-420-8345
Mailing Address - Fax:972-420-7770
Practice Address - Street 1:130 MELVILLE AVE
Practice Address - Street 2:
Practice Address - City:SAN ANSELMO
Practice Address - State:CA
Practice Address - Zip Code:94960-2719
Practice Address - Country:US
Practice Address - Phone:972-420-8345
Practice Address - Fax:972-420-7770
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0403182084P0800X
KY315132084P0800X
CAG92242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG11968Medicare UPIN