Provider Demographics
NPI:1770674905
Name:LEVAN, MAURICE XUAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:XUAN
Last Name:LEVAN
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 1:404 ROCKBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-6013
Mailing Address - Country:US
Mailing Address - Phone:609-926-0885
Mailing Address - Fax:
Practice Address - Street 1:1175 DEHIRSCH AVE
Practice Address - Street 2:
Practice Address - City:WOODBINE
Practice Address - State:NJ
Practice Address - Zip Code:08270-2401
Practice Address - Country:US
Practice Address - Phone:609-861-2164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04760900208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ631834B1GOtherMEDICARE BILLING NO
NJ4472004Medicaid
NJ4472004Medicaid