Provider Demographics
NPI:1043219363
Name:LEVINSON, BRADLEY A (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:A
Last Name:LEVINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 BRANDT DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-6437
Mailing Address - Country:US
Mailing Address - Phone:724-741-6020
Mailing Address - Fax:724-741-6022
Practice Address - Street 1:105 BRANDT DR
Practice Address - Street 2:SUITE 202
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-6437
Practice Address - Country:US
Practice Address - Phone:724-741-6020
Practice Address - Fax:724-741-6022
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031375E208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1252156Medicaid
PA003918OtherHIGHMARK BLUE CROSS BLUE SHIELD
PA80547OtherAETNA US HEALTHCARE
PA224255YE57Medicare PIN
PA1252156Medicaid
PA80547OtherAETNA US HEALTHCARE