Provider Demographics
NPI:1689601791
Name:LEVINE, RICHARD TEDDY (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:TEDDY
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3458 NEELEY ROAD
Mailing Address - Street 2:305TH MEDICAL GROUP
Mailing Address - City:MCGUIRE AFB
Mailing Address - State:NJ
Mailing Address - Zip Code:08641
Mailing Address - Country:US
Mailing Address - Phone:609-261-6701
Mailing Address - Fax:609-261-9362
Practice Address - Street 1:120 MADISON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-2055
Practice Address - Country:US
Practice Address - Phone:609-261-4925
Practice Address - Fax:609-261-9362
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA03356800207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ000163008OtherHIGHMARK BLUE SHIELD
NJ0016729OtherAETNA HMO
NJ0085815000OtherAMERIHEALTH HMO
NJ2284006Medicaid
NJ163008MKCMedicare ID - Type Unspecified
NJ0085815000OtherAMERIHEALTH HMO