Provider Demographics
NPI:1780675934
Name:LEVITOV, ALEXANDER B (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:B
Last Name:LEVITOV
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:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-5758
Mailing Address - Fax:757-446-7452
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:SUITE 445
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-5758
Practice Address - Fax:757-446-7452
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-233685207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA-029OtherTRICARE/CHAMPUS
VA10052670OtherSENTARA/OPTIMA HEALTH
VAPAROtherCORVEL/CORCARE
VAPAROtherUSA MANAGED CARE
VAPAROtherFIRST HEALTH COMMERCIAL/COVENTRY HEALTH/SOUTHERN HEALTH
VAPAROtherCIGNA
NC5913416Medicaid
VAPAROtherVA HEALTH NETWORK
VAPAROtherVA PREMIER HEALTH
VAPAROtherUNITED HEALTH CARE/MAMSI
VA1780675934Medicaid
VA5878039Medicaid
VAPAROtherAETNA
VAPAROtherMULTIPLAN
VA379294OtherANTHEM BC/BS
VA1780675934Medicaid
VA810000998Medicare PIN
VAP00785538Medicare PIN
VAPAROtherUSA MANAGED CARE
VAPAROtherVA HEALTH NETWORK