1144350711 NPI number — DR. DANIEL JACOB LEVINE MD

Table of content: DR. DANIEL JACOB LEVINE MD (NPI 1144350711)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144350711 NPI number — DR. DANIEL JACOB LEVINE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEVINE
Provider First Name:
DANIEL
Provider Middle Name:
JACOB
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1144350711
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10215 FERNWOOD RD
Provider Second Line Business Mailing Address:
SUITE # 520
Provider Business Mailing Address City Name:
BETHESDA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20817
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-897-0099
Provider Business Mailing Address Fax Number:
301-897-8537

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10215 FERNWOOD RD
Provider Second Line Business Practice Location Address:
SUITE # 520
Provider Business Practice Location Address City Name:
BETHESDA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-897-0099
Provider Business Practice Location Address Fax Number:
301-897-8537
Provider Enumeration Date:
03/06/2007

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: 2084P0800X , with the licence number:  D32168 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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