Provider Demographics
NPI:1124010632
Name:LEVY, DANIEL JAY (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JAY
Last Name:LEVY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10085 RED RUN BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4836
Mailing Address - Country:US
Mailing Address - Phone:410-363-1843
Mailing Address - Fax:410-363-3027
Practice Address - Street 1:10085 RED RUN BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4836
Practice Address - Country:US
Practice Address - Phone:410-363-1843
Practice Address - Fax:410-363-3027
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2013-04-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD020742208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD313011800Medicaid
MD313011800Medicaid