Provider Demographics
NPI:1578505087
Name:LEVATINO, ANTHONY P (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:P
Last Name:LEVATINO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1135 S MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-2946
Mailing Address - Country:US
Mailing Address - Phone:575-522-9082
Mailing Address - Fax:575-521-9169
Practice Address - Street 1:1135 S MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2946
Practice Address - Country:US
Practice Address - Phone:575-522-9082
Practice Address - Fax:575-521-9169
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2015-11-23
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Provider Licenses
StateLicense IDTaxonomies
NM2002-0273207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM09130586Medicaid
NM09130586Medicaid