Provider Demographics
NPI:1477548410
Name:LEVENTHAL, MARVIN R (MD)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:R
Last Name:LEVENTHAL
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 1:151 GREENBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-3207
Mailing Address - Country:US
Mailing Address - Phone:901-359-5916
Mailing Address - Fax:901-359-5916
Practice Address - Street 1:151 GREENBRIAR DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-3207
Practice Address - Country:US
Practice Address - Phone:901-641-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000014069207X00000X
TN14069207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4228430OtherBCBS OF TN
757472OtherUNITED HEALTH
2612449OtherCIGNA
TN00756264OtherRR MEDICARE
TN1514479Medicaid
TN4228430OtherBCBS OF TN
757472OtherUNITED HEALTH