Provider Demographics
NPI:1073618187
Name:LEVY, DAVID ALAN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALAN
Last Name:LEVY
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 1:900 ELKRIDGE LANDING RD FL 2
Mailing Address - Street 2:
Mailing Address - City:LINTHICUM
Mailing Address - State:MD
Mailing Address - Zip Code:21090-2924
Mailing Address - Country:US
Mailing Address - Phone:443-462-5010
Mailing Address - Fax:
Practice Address - Street 1:5 N LA PLATA CT STE 202
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-5208
Practice Address - Country:US
Practice Address - Phone:301-609-4866
Practice Address - Fax:240-448-3117
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0089162208800000X
OH35060814208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2713004Medicaid
OH750849OtherBUCKEYE
OH000000215239OtherUNISON
OH415000OtherWELLCARE
OH5999527OtherAETNA
OH000000513620OtherANTHEM
MD87-1469742Medicaid
OHP00412484OtherRAILROAD MEDICARE
OHP00412484OtherRAILROAD MEDICARE