Provider Demographics
NPI:1801826342
Name:LEVY, WILLIAM J (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:LEVY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:12070 OLD LINE CTR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-2513
Mailing Address - Country:US
Mailing Address - Phone:301-870-4100
Mailing Address - Fax:301-870-5109
Practice Address - Street 1:12070 OLD LINE CTR
Practice Address - Street 2:SUITE 102
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2513
Practice Address - Country:US
Practice Address - Phone:301-870-4100
Practice Address - Fax:301-870-5109
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0033004207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD400751400Medicaid
MDKK16 HN18Medicare ID - Type Unspecified
MD400751400Medicaid