Provider Demographics
NPI:1063662807
Name:LEWIS LEVIN MD LLC
Entity Type:Organization
Organization Name:LEWIS LEVIN MD LLC
Other - Org Name:LEWIS LEVIN MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-238-7646
Mailing Address - Street 1:54 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-5740
Mailing Address - Country:US
Mailing Address - Phone:203-238-7646
Mailing Address - Fax:203-238-0225
Practice Address - Street 1:54 HIGH ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-5740
Practice Address - Country:US
Practice Address - Phone:203-238-7646
Practice Address - Fax:203-238-0225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-29
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT017559207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080184851OtherRAILROAD MEDICARE
CT001175595Medicaid
CT010017559CT01OtherBLUE CROSS
CT080184851OtherRAILROAD MEDICARE