Provider Demographics
NPI:1578548186
Name:LEVENSON, SCOTT DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:DAVID
Last Name:LEVENSON
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:PO BOX 7625
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94026-7625
Mailing Address - Country:US
Mailing Address - Phone:650-596-8800
Mailing Address - Fax:650-596-8802
Practice Address - Street 1:1000 LAUREL ST
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-3919
Practice Address - Country:US
Practice Address - Phone:650-596-8800
Practice Address - Fax:650-596-8802
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG071807207RG0100X
CAG71807207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G718071Medicaid
CAF73438Medicare UPIN
CA00G718071Medicaid