Provider Demographics
NPI:1275569956
Name:LEVINE, LAWRENCE ALLEN (DPM)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:ALLEN
Last Name:LEVINE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 BERLIN RD
Mailing Address - Street 2:SUITE 5000
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-3574
Mailing Address - Country:US
Mailing Address - Phone:856-795-1003
Mailing Address - Fax:856-795-5994
Practice Address - Street 1:52 BERLIN RD
Practice Address - Street 2:SUITE 5000
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-3574
Practice Address - Country:US
Practice Address - Phone:856-795-1003
Practice Address - Fax:856-795-5994
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00092600213E00000X
PASC001429L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0090238000OtherPA BLUE SHIELD
F14284OtherHEALTH NET
PAFO110209OtherKEYSTONE MERCY
0070293OtherGROUP HEALTH INS.
NJ14952OtherAMERIGROUP
4394780OtherAETNA
NJ0004916OtherAETNA
NJCA000033400OtherAMERICHOICE OF NJ
NJ1085556OtherHORIZON NJ HEALTH
NJ155550201Medicaid
4800233093OtherRAIL ROAD MEDICARE
16720OtherUNIVERSITY HEALTH PLAN
NJ24074OtherOPERATING ENGINEERS
P898164OtherOXFORD
NJCA000033400OtherAMERICHOICE OF NJ
4800233093OtherRAIL ROAD MEDICARE
PA0000054016Medicare NSC
F14284OtherHEALTH NET
16720OtherUNIVERSITY HEALTH PLAN