Provider Demographics
NPI:1376589499
Name:LEVINE, RICHARD LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:LAWRENCE
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 1:1115 HEALING SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37419-1043
Mailing Address - Country:US
Mailing Address - Phone:561-601-6339
Mailing Address - Fax:
Practice Address - Street 1:980 HIGHWAY 28
Practice Address - Street 2:SUITE 201
Practice Address - City:JASPER
Practice Address - State:TN
Practice Address - Zip Code:37347-3695
Practice Address - Country:US
Practice Address - Phone:423-942-2000
Practice Address - Fax:423-942-2023
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA03092R208800000X
WI17433 020208800000X
TN41293208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D79359Medicare UPIN
TN3828027Medicare ID - Type Unspecified