Provider Demographics
NPI:1295824290
Name:LEVINE, DAVID BARRY (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:BARRY
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:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:844-362-1735
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:451 TERRILL RD
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07062-1377
Practice Address - Country:US
Practice Address - Phone:908-941-9490
Practice Address - Fax:908-941-9491
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08070000208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5551315OtherCIGNA
2765828000OtherAMERIHEALTH
NJ3K5368OtherHEALTH NET