Provider Demographics
NPI:1568473494
Name:LEVIN, WAYNE S (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:S
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 1:3690 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606
Mailing Address - Country:US
Mailing Address - Phone:203-579-9000
Mailing Address - Fax:203-374-6132
Practice Address - Street 1:3690 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606
Practice Address - Country:US
Practice Address - Phone:203-579-9000
Practice Address - Fax:203-374-6132
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT20625207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4292492OtherAETNA
702165OtherCONNECTICARE
CT010020625CT01OtherANTHEM BS
CTOV9670OtherHEALTHNET
061002165OtherCIGNA
ZP382OtherOXFORD
CT001206259Medicaid
CT001206259Medicaid
D03015Medicare UPIN