Provider Demographics
NPI:1164406724
Name:LEVITT, CHAD ADAM (MD)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:ADAM
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:PO BOX 102543
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2543
Mailing Address - Country:US
Mailing Address - Phone:404-605-4227
Mailing Address - Fax:770-916-4434
Practice Address - Street 1:1968 PEACHTREE RD NW
Practice Address - Street 2:RADIATION ONCOLOGY DEPT
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309
Practice Address - Country:US
Practice Address - Phone:404-605-3319
Practice Address - Fax:770-916-4434
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0539312085R0001X, 2085R0001X
CO429402085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO13601261Medicaid
FL277225600Medicaid
FL90951OtherBCBS OF FL
GA202G708456OtherMEDICARE ID
FL277225600Medicaid
FL277225600Medicaid
CO13601261Medicaid
AA077ZMedicare PIN