1104061712 NPI number — MARK DAVID LEVINE, MD, CONCORD PROFESSIONAL CORPORATION

Table of content: (NPI 1104061712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104061712 NPI number — MARK DAVID LEVINE, MD, CONCORD PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARK DAVID LEVINE, MD, CONCORD PROFESSIONAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COMMUNITY PSYCHIATRY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104061712
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2081 ARENA BLVD
Provider Second Line Business Mailing Address:
STE 160
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95834
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-576-7898
Provider Business Mailing Address Fax Number:
916-285-0338

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2485 HIGH SCHOOL AVE
Provider Second Line Business Practice Location Address:
STE 218
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94520-1819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-356-0561
Provider Business Practice Location Address Fax Number:
925-556-0485
Provider Enumeration Date:
12/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LEVINE
Authorized Official First Name:
MARK
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
925-356-0561

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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