Provider Demographics
NPI:1285833509
Name:LEVICK, MARVIN H (MD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:H
Last Name:LEVICK
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 1:2453 W PIKE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:PA
Mailing Address - Zip Code:15342-1160
Mailing Address - Country:US
Mailing Address - Phone:724-873-5655
Mailing Address - Fax:724-873-5656
Practice Address - Street 1:2453 W PIKE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:PA
Practice Address - Zip Code:15342-1160
Practice Address - Country:US
Practice Address - Phone:724-873-5655
Practice Address - Fax:724-873-5656
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM2800X
PAMD027797L261QM2800X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00820974Medicaid
PA00820974Medicaid