Provider Demographics
NPI:1164631834
Name:IRA D LEVINE MD INC
Entity Type:Organization
Organization Name:IRA D LEVINE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-298-8891
Mailing Address - Street 1:4060 4TH AVE STE 440
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2183
Mailing Address - Country:US
Mailing Address - Phone:619-298-8891
Mailing Address - Fax:619-298-4997
Practice Address - Street 1:4060 4TH AVE STE 440
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2183
Practice Address - Country:US
Practice Address - Phone:619-298-8891
Practice Address - Fax:619-298-4997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty