1114108768 NPI number — SCOTT D LEVENSON, MD

Table of content: (NPI 1114108768)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114108768 NPI number — SCOTT D LEVENSON, MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCOTT D LEVENSON, MD
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:
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:
1114108768
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7625
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MENLO PARK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94026-7625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-596-8800
Provider Business Mailing Address Fax Number:
650-596-8802

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 LAUREL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN CARLOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94070-3939
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-596-8800
Provider Business Practice Location Address Fax Number:
650-596-8802
Provider Enumeration Date:
11/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LEVENSON
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
650-596-8800

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  G71807 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RG0100X , with the licence number: A98824 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: BBB12433B . This is a "MEDAVANT SUBMITTER ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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