Provider Demographics
NPI:1225047863
Name:LEVENTHAL, STUART P (MD)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:P
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:PO BOX 320863
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-0863
Mailing Address - Country:US
Mailing Address - Phone:601-919-6590
Mailing Address - Fax:
Practice Address - Street 1:123 MCCOMB AVE
Practice Address - Street 2:
Practice Address - City:PORT GIBSON
Practice Address - State:MS
Practice Address - Zip Code:39150-2915
Practice Address - Country:US
Practice Address - Phone:601-437-5141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19158207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC08707Medicare UPIN