Provider Demographics
NPI:1043385974
Name:LEVINE, SCOTT DAVID (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:DAVID
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:8527 SUMMERVILLE PL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-3930
Mailing Address - Country:US
Mailing Address - Phone:407-351-9040
Mailing Address - Fax:407-363-9538
Practice Address - Street 1:7350 SANDLAKE COMMONS
Practice Address - Street 2:2215
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819
Practice Address - Country:US
Practice Address - Phone:407-363-1515
Practice Address - Fax:407-363-9538
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME55318207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL08914Medicare UPIN