Provider Demographics
NPI:1275853590
Name:DAVID A LEVINE M D INC
Entity Type:Organization
Organization Name:DAVID A LEVINE M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-522-8878
Mailing Address - Street 1:4957 38TH AVE N
Mailing Address - Street 2:SUITE B
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-2174
Mailing Address - Country:US
Mailing Address - Phone:727-522-8878
Mailing Address - Fax:727-521-1192
Practice Address - Street 1:4957 38TH AVE N
Practice Address - Street 2:SUITE B
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-2174
Practice Address - Country:US
Practice Address - Phone:727-522-8878
Practice Address - Fax:727-521-1192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51828207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE22424Medicare UPIN