Provider Demographics
NPI:1376532135
Name:LEVY, ALAN BRUCE (MD)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:BRUCE
Last Name:LEVY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3545 OLENTANGY RIVER RD
Mailing Address - Street 2:SUITE 510
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3907
Mailing Address - Country:US
Mailing Address - Phone:614-263-5598
Mailing Address - Fax:614-263-5387
Practice Address - Street 1:3545 OLENTANGY RIVER RD
Practice Address - Street 2:SUITE 510
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3907
Practice Address - Country:US
Practice Address - Phone:614-263-5598
Practice Address - Fax:614-263-5387
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35049037L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH463013000OtherMAGELLAN
C02553Medicare UPIN
OH0532741Medicare ID - Type Unspecified