Provider Demographics
NPI:1124192869
Name:LEVENTHAL, WALTER DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:DAVID
Last Name:LEVENTHAL
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 1:299 MIDLAND PKWY # A
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8104
Mailing Address - Country:US
Mailing Address - Phone:843-875-7901
Mailing Address - Fax:843-832-2038
Practice Address - Street 1:299 MIDLAND PKWY # A
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8104
Practice Address - Country:US
Practice Address - Phone:843-875-7901
Practice Address - Fax:843-832-2038
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8929207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC089291Medicaid
SC089291Medicaid