Provider Demographics
NPI:1487820817
Name:LEVINE, LYNDA GOLDBERG (DO)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:GOLDBERG
Last Name:LEVINE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14322 NIGHT HAWK WAY
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-4334
Mailing Address - Country:US
Mailing Address - Phone:301-642-3609
Mailing Address - Fax:
Practice Address - Street 1:1225 MARTHA CUSTIS DR STE C7
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-2040
Practice Address - Country:US
Practice Address - Phone:240-813-8326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102205894207Q00000X
DEC7-0003993207Q00000X
MDH0072423207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC224514Medicare PIN