Provider Demographics
NPI:1790902245
Name:DR. ROBERT E. LEVIN
Entity Type:Organization
Organization Name:DR. ROBERT E. LEVIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-691-1044
Mailing Address - Street 1:131 BOSTON POST RD
Mailing Address - Street 2:P.O. BOX 490
Mailing Address - City:EAST LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06333
Mailing Address - Country:US
Mailing Address - Phone:860-691-1044
Mailing Address - Fax:860-691-1050
Practice Address - Street 1:131 BOSTON POST RD
Practice Address - Street 2:SUITE 5
Practice Address - City:EAST LYME
Practice Address - State:CT
Practice Address - Zip Code:06333
Practice Address - Country:US
Practice Address - Phone:860-691-1044
Practice Address - Fax:860-691-1050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT023047207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD33503Medicare UPIN
CTC02456Medicare ID - Type Unspecified