Provider Demographics
NPI:1740233709
Name:LEVIN, MARY ILENE (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ILENE
Last Name:LEVIN
Suffix:
Gender:F
Credentials:MD
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Other - Middle Name:
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Mailing Address - Street 1:11301 WILSHIRE BLVD
Mailing Address - Street 2:VAMC--DOM 129
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90073-1003
Mailing Address - Country:US
Mailing Address - Phone:310-478-3711
Mailing Address - Fax:310-268-4864
Practice Address - Street 1:11301 WILSHIRE BLVD
Practice Address - Street 2:VAMC--DOM 129
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073-1003
Practice Address - Country:US
Practice Address - Phone:310-478-3711
Practice Address - Fax:310-268-4864
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine