Provider Demographics
NPI:1184826034
Name:EDWARD A LEVY MD INC
Entity Type:Organization
Organization Name:EDWARD A LEVY MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-899-9993
Mailing Address - Street 1:850 COLUMBIA RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-1493
Mailing Address - Country:US
Mailing Address - Phone:440-899-9993
Mailing Address - Fax:440-899-8065
Practice Address - Street 1:850 COLUMBIA RD
Practice Address - Street 2:SUITE 103
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1493
Practice Address - Country:US
Practice Address - Phone:440-899-9993
Practice Address - Fax:440-899-8065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-063360174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0975477Medicaid
OH=========-00OtherBWC
OHED0762671Medicare ID - Type Unspecified
OH=========-00OtherBWC