Provider Demographics
NPI:1255330783
Name:LEVINE, MAX PHILLIP (MD)
Entity Type:Individual
Prefix:DR
First Name:MAX
Middle Name:PHILLIP
Last Name:LEVINE
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 1:1037 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-1815
Mailing Address - Country:US
Mailing Address - Phone:434-792-6117
Mailing Address - Fax:434-792-4619
Practice Address - Street 1:1037 MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-1815
Practice Address - Country:US
Practice Address - Phone:434-792-6117
Practice Address - Fax:434-792-4619
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010483042086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790573WMedicaid
VA074218OtherANTHEM PROVIDER NUMBER
VA074218OtherANTHEM PROVIDER NUMBER