Provider Demographics
NPI:1124036793
Name:LEVITT, ROBERT M (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:LEVITT
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 1:400 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-3207
Mailing Address - Country:US
Mailing Address - Phone:330-602-7702
Mailing Address - Fax:330-602-4169
Practice Address - Street 1:400 MEDICAL PARK DR
Practice Address - Street 2:SUITE 203
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-3207
Practice Address - Country:US
Practice Address - Phone:330-602-7702
Practice Address - Fax:330-602-4169
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-064326174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCG7848OtherRR MEDICARE GROUP #
OH000000538784OtherANTHEM
OH0266626Medicaid
OH341882527OtherTAX ID
OHP00458762OtherRR MEDICARE
OH1124036793OtherNPI
OH9301652OtherMEDICARE GROUP #
OH2187360OtherMEDICAID GROUP #
OH341882527QOtherAULTCARE
OH4223451Medicare PIN