Provider Demographics
NPI:1033153358
Name:JONATHAN L LEVINE MD, PC
Entity Type:Organization
Organization Name:JONATHAN L LEVINE MD, PC
Other - Org Name:ENT ASSOCIATES OF ALABAMA, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:C
Authorized Official - Last Name:O'NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-631-8116
Mailing Address - Street 1:833 SAINT VINCENTS DR
Mailing Address - Street 2:POB #3 SUITE 402
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1606
Mailing Address - Country:US
Mailing Address - Phone:205-631-8116
Mailing Address - Fax:205-631-8114
Practice Address - Street 1:931 SHARIT AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071
Practice Address - Country:US
Practice Address - Phone:205-631-8116
Practice Address - Fax:205-631-8114
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENT ASSOCIATES OF ALABAMA, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-16
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00020375207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALG02657Medicare UPIN