Provider Demographics
NPI:1417973306
Name:LEVIN, LEWIS (MD)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:
Last Name:LEVIN
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 1:434 WEXFORD PL
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-1821
Mailing Address - Country:US
Mailing Address - Phone:203-272-3062
Mailing Address - Fax:203-238-0225
Practice Address - Street 1:54 HIGH ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-5740
Practice Address - Country:US
Practice Address - Phone:203-238-7646
Practice Address - Fax:203-238-0225
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT017559207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010017559CT01OtherBLUE CROSS
CT080184851OtherRAILROAD MEDICARE
CT080001416Medicare UPIN