Provider Demographics
NPI:1457319550
Name:LEVY, KENNETH M (DO)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:M
Last Name:LEVY
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:8400 ROOSEVELT BLVD
Mailing Address - Street 2:STE 206
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-2081
Mailing Address - Country:US
Mailing Address - Phone:215-333-7560
Mailing Address - Fax:215-333-7563
Practice Address - Street 1:8400 ROOSEVELT BLVD
Practice Address - Street 2:STE 206
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-2081
Practice Address - Country:US
Practice Address - Phone:215-333-7560
Practice Address - Fax:215-333-7563
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PA0S007464L2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
F39158Medicare UPIN
077408Medicare ID - Type Unspecified