1457344921 NPI number — JEFFREY HARRIS LEVINE MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457344921 NPI number — JEFFREY HARRIS LEVINE MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

LEVINE

Provider First Name:

JEFFREY

Provider Middle Name:

HARRIS

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1457344921

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

10/21/2019

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

104 E 2ND ST

Provider Second Line Business Mailing Address:

7TH FLOOR

Provider Business Mailing Address City Name:

ERIE

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

16507-1532

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

814-877-6111

Provider Business Mailing Address Fax Number:

814-877-6356

Provider First Line Business Practice Location Address:

9141 GRANT ST STE 125

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

THORNTON

Provider Business Practice Location Address State Name:

CO

Provider Business Practice Location Address Postal Code:

80229-4367

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

303-453-2460

Provider Business Practice Location Address Fax Number:

303-453-2460

Provider Enumeration Date:

08/30/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208600000X , with the licence number:  MD067802L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 00025821201 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 1508396 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 0017599780004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1068850 . This is a "WEST VIRGINIA WORK COMP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
• Identifier: 119508 . This is a "UNISON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 2988615 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 217386 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 02166407 . This is a "NY MEDICAL ASSISTANCE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 612674 . This is a "BLUESHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 020049122 . This is a "RR MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 2248875 . This is a "OH MEDICAL ASSISTANCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".