Provider Demographics
NPI:1689995433
Name:DAVID J. LEVINE, M.D., P.A.
Entity Type:Organization
Organization Name:DAVID J. LEVINE, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-977-2300
Mailing Address - Street 1:19271 MONTGOMERY VILLAGE AVE
Mailing Address - Street 2:SUITE H-2
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-5021
Mailing Address - Country:US
Mailing Address - Phone:301-977-2300
Mailing Address - Fax:301-977-2348
Practice Address - Street 1:19271 MONTGOMERY VILLAGE AVE
Practice Address - Street 2:SUITE H-2
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886-5021
Practice Address - Country:US
Practice Address - Phone:301-977-2300
Practice Address - Fax:301-977-2348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD188721100Medicaid
MD188721100Medicaid