1801862941 NPI number — LEONARD A LEVIN MD PHD

Table of content: LEONARD A LEVIN MD PHD (NPI 1801862941)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801862941 NPI number — LEONARD A LEVIN MD PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEVIN
Provider First Name:
LEONARD
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD PHD
Provider Gender Code:
M

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:
1801862941
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2396 GRAHAM BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONT-ROYAL
Provider Business Mailing Address State Name:
QC
Provider Business Mailing Address Postal Code:
H3R1H9
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5252 BOUL DE MAISONNEUVE OUEST
Provider Second Line Business Practice Location Address:
STE 400
Provider Business Practice Location Address City Name:
MONTREAL
Provider Business Practice Location Address State Name:
QC
Provider Business Practice Location Address Postal Code:
H4A3S5
Provider Business Practice Location Address Country Code:
CA
Provider Business Practice Location Address Telephone Number:
514-843-1544
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/28/2006

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: 207WX0109X , with the licence number:  34469-20 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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