Provider Demographics
NPI:1568499457
Name:LEVIN, GARY J (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:J
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 1:3000 C G ZINN RD
Mailing Address - Street 2:THE GREENVIEW PAVILION
Mailing Address - City:THORNDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19372
Mailing Address - Country:US
Mailing Address - Phone:610-384-9100
Mailing Address - Fax:610-384-3937
Practice Address - Street 1:3000 C G ZINN RD
Practice Address - Street 2:THE GREENVIEW PAVILION
Practice Address - City:THORNDALE
Practice Address - State:PA
Practice Address - Zip Code:19372
Practice Address - Country:US
Practice Address - Phone:610-384-9100
Practice Address - Fax:610-384-3937
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD015502E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006051440001Medicaid
PA78291G69Medicare PIN
PA1181000001Medicare NSC
C29178Medicare UPIN