Provider Demographics
NPI:1750319513
Name:LEVY, CHANAN (MD)
Entity Type:Individual
Prefix:MR
First Name:CHANAN
Middle Name:
Last Name:LEVY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 UPPER CHESAPEAKE DR
Mailing Address - Street 2:STE 518
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4328
Mailing Address - Country:US
Mailing Address - Phone:443-643-4530
Mailing Address - Fax:443-643-4535
Practice Address - Street 1:510 UPPER CHESAPEAKE DR
Practice Address - Street 2:STE 518
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4328
Practice Address - Country:US
Practice Address - Phone:443-643-4530
Practice Address - Fax:443-643-4535
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0060444207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD402830900Medicaid
MD402830900Medicaid
H95056Medicare UPIN