Provider Demographics
NPI:1689811739
Name:LEVY, MARK I (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:I
Last Name:LEVY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:655 REDWOOD HWY
Mailing Address - Street 2:SUITE 271
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-3034
Mailing Address - Country:US
Mailing Address - Phone:415-388-8040
Mailing Address - Fax:415-634-2400
Practice Address - Street 1:655 REDWOOD HWY
Practice Address - Street 2:SUITE 271
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-3034
Practice Address - Country:US
Practice Address - Phone:415-388-8040
Practice Address - Fax:415-634-2400
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG226582084F0202X, 2084P0800X
HIMD-130592084F0202X, 2084P0800X
NC2014-023532084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry