1073606216 NPI number — TERRY L LEVIN MD

Table of content: TERRY L LEVIN MD (NPI 1073606216)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073606216 NPI number — TERRY L LEVIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEVIN
Provider First Name:
TERRY
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1073606216
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3695 GREEN RD
Provider Second Line Business Mailing Address:
UNIT 22778
Provider Business Mailing Address City Name:
BEACHWOOD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44122-7939
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-655-1869
Provider Business Mailing Address Fax Number:
330-655-3828

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5655 HUDSON DR STE 210
Provider Second Line Business Practice Location Address:
ARIS RADIOLOGY
Provider Business Practice Location Address City Name:
HUDSON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44236-4455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-655-1869
Provider Business Practice Location Address Fax Number:
330-655-3828
Provider Enumeration Date:
10/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085P0229X , with the licence number:  036-124028 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 167995 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 04-33839 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 2009017808 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: G154413 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085P0229X , with the licence number: G154413 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4383812 . This is a "AETNA- KCR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000057058K . This is a "HUMANA- KCR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 201025850 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50030566 . This is a "PASSPORT- KCR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 0000685190 . This is a "ANTHEM- KCR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100115270 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".