Provider Demographics
NPI:1558408765
Name:LEVY, MATTHEW JASON (DO)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JASON
Last Name:LEVY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:6201 GREENLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2004
Mailing Address - Country:US
Mailing Address - Phone:410-933-2704
Mailing Address - Fax:410-955-0141
Practice Address - Street 1:600 N WOLFE ST
Practice Address - Street 2:MARBURG B-186
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0005
Practice Address - Country:US
Practice Address - Phone:410-955-8708
Practice Address - Fax:410-955-0141
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2023-05-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDT1875207P00000X
MDH66481207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD023235100Medicaid
MD155354Y9QMedicare PIN