Provider Demographics
NPI:1134130651
Name:LEVINE, GAIL L (MD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:L
Last Name:LEVINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:100 W CALIFORNIA BLVD
Mailing Address - Street 2:NEONATOLOGY DIVISION
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3010
Mailing Address - Country:US
Mailing Address - Phone:626-397-8524
Mailing Address - Fax:626-397-2954
Practice Address - Street 1:100 W CALIFORNIA BLVD
Practice Address - Street 2:NEONATOLOGY DIVISION
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3010
Practice Address - Country:US
Practice Address - Phone:626-397-8524
Practice Address - Fax:626-397-2954
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG659722080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE24896Medicare UPIN