Provider Demographics
NPI:1558493445
Name:LEVIN, RICHARD WENDER (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WENDER
Last Name:LEVIN
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 1:3810 HOLLYWOOD BLVD
Mailing Address - Street 2:#2
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021
Mailing Address - Country:US
Mailing Address - Phone:954-962-3888
Mailing Address - Fax:954-962-3936
Practice Address - Street 1:3810 HOLLYWOOD BLVD
Practice Address - Street 2:#2
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021
Practice Address - Country:US
Practice Address - Phone:954-962-3888
Practice Address - Fax:954-962-3936
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL265412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
D60462Medicare UPIN