Provider Demographics
NPI:1497707459
Name:LEVINE, MARSHALL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:A
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:PO BOX 418953
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-8953
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6569 N CHARLES ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-6831
Practice Address - Country:US
Practice Address - Phone:443-849-3051
Practice Address - Fax:443-849-3057
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD17873207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKJ44GB/33022003OtherCAREFIRST OF MD GBMC
MDS1240004OtherCAREFIRST REGIONAL GBMC
MD185511500Medicaid
MD185511500Medicaid
MD705L706ZMedicare PIN
MDS1240004OtherCAREFIRST REGIONAL GBMC
MD900003128Medicare PIN