Provider Demographics
NPI:1629077250
Name:LEVINE, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:LEVINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 BALTIMORE BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-6105
Mailing Address - Country:US
Mailing Address - Phone:410-848-8628
Mailing Address - Fax:410-848-3909
Practice Address - Street 1:505B E RIDGEVILLE BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-5251
Practice Address - Country:US
Practice Address - Phone:301-607-9096
Practice Address - Fax:301-607-8049
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15098225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2118118OtherAETNA HMO
393465OtherMAMSI-UHC
MDH481DO-61198503OtherCAREFIRST BLUECROSS
5060511OtherAETNA NON HMO
DCT615-0003OtherCAREFIRST BLUECHOICE
393465OtherMAMSI-UHC