Provider Demographics
NPI:1336320522
Name:LAWRENCE LEVIN MD INC
Entity Type:Organization
Organization Name:LAWRENCE LEVIN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT ACCTS SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:STOREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-245-6012
Mailing Address - Street 1:1365 POPLAR DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-5207
Mailing Address - Country:US
Mailing Address - Phone:541-245-6012
Mailing Address - Fax:541-245-6012
Practice Address - Street 1:1365 POPLAR DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-5207
Practice Address - Country:US
Practice Address - Phone:541-245-6012
Practice Address - Fax:541-245-6012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR286445Medicaid
ORR114099Medicare PIN
OR286445Medicaid