Provider Demographics
NPI:1114108768
Name:SCOTT D LEVENSON, MD
Entity Type:Organization
Organization Name:SCOTT D LEVENSON, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-596-8800
Mailing Address - Street 1:PO BOX 7625
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94026-7625
Mailing Address - Country:US
Mailing Address - Phone:650-596-8800
Mailing Address - Fax:650-596-8802
Practice Address - Street 1:1000 LAUREL ST
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-3939
Practice Address - Country:US
Practice Address - Phone:650-596-8800
Practice Address - Fax:650-596-8802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-23
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71807207RG0100X
CAA98824207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABBB12433BOtherMEDAVANT SUBMITTER ID
CAZZZ29930ZMedicare PIN