Provider Demographics
NPI:1063456499
Name:LEVINE, NORMAN B (DPM)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:B
Last Name:LEVINE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-3749
Mailing Address - Country:US
Mailing Address - Phone:203-227-9345
Mailing Address - Fax:203-454-0212
Practice Address - Street 1:29 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-3749
Practice Address - Country:US
Practice Address - Phone:203-227-9345
Practice Address - Fax:203-454-0212
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT000111213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004130663Medicaid
CTU01260Medicare UPIN
CT004130663Medicaid
CT480000230Medicare PIN