Provider Demographics
NPI:1386670628
Name:RICHARD A LEVINE MD FACP PA
Entity Type:Organization
Organization Name:RICHARD A LEVINE MD FACP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-368-0191
Mailing Address - Street 1:7280 W PALMETTO PARK RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3422
Mailing Address - Country:US
Mailing Address - Phone:561-368-0191
Mailing Address - Fax:561-368-0151
Practice Address - Street 1:7280 W PALMETTO PARK RD
Practice Address - Street 2:SUITE 205
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3422
Practice Address - Country:US
Practice Address - Phone:561-368-0191
Practice Address - Fax:561-368-0151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 45831207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9324Medicare PIN