Provider Demographics
NPI:1376578054
Name:LEVINE, JEDD FRANKLIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEDD
Middle Name:FRANKLIN
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 1:200 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-3096
Mailing Address - Country:US
Mailing Address - Phone:860-482-5384
Mailing Address - Fax:860-489-1799
Practice Address - Street 1:200 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-3096
Practice Address - Country:US
Practice Address - Phone:860-482-5384
Practice Address - Fax:860-496-4951
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT026385207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT13181OtherCT CONTROLLED SUBSTANCE
CT026385OtherCT LICENSE
CT026385OtherCT LICENSE
AL9397793OtherDEA
C00633Medicare ID - Type UnspecifiedMR GROUP #
CT026385OtherCT LICENSE