Provider Demographics
NPI:1588834691
Name:LEVINE, BENJAMIN (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:6 MONTGOMERY VILLAGE AVE STE 340
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3572
Mailing Address - Country:US
Mailing Address - Phone:301-977-2300
Mailing Address - Fax:301-977-2348
Practice Address - Street 1:6 MONTGOMERY VILLAGE AVE STE 340
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3572
Practice Address - Country:US
Practice Address - Phone:301-977-2300
Practice Address - Fax:301-977-2348
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY237552207W00000X
MDD0089851207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology