Provider Demographics
NPI:1669823175
Name:LEVINE, DAVID WEINTHROP (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:WEINTHROP
Last Name:LEVINE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:832 WALDEN AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14211-2639
Mailing Address - Country:US
Mailing Address - Phone:716-381-9046
Mailing Address - Fax:716-436-3187
Practice Address - Street 1:832 WALDEN AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14211-2639
Practice Address - Country:US
Practice Address - Phone:716-381-9046
Practice Address - Fax:716-436-3187
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-27
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2463172085R0202X
NY60246317208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice