Provider Demographics
NPI:1477597664
Name:LEVINE, RICHARD G (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:G
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 1:3333 N CALVERT ST
Mailing Address - Street 2:STE 400
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218
Mailing Address - Country:US
Mailing Address - Phone:410-554-2270
Mailing Address - Fax:410-261-2726
Practice Address - Street 1:3333 N CALVERT ST
Practice Address - Street 2:STE 400
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2867
Practice Address - Country:US
Practice Address - Phone:410-554-2270
Practice Address - Fax:410-261-2726
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0055411207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCJ848OtherCFBCBS DC
MD60835103OtherBCBS
MD903AOtherCFBCBS MD
DCJ848OtherCFBCBS DC
H31711Medicare UPIN
MD112NMedicare PIN