Provider Demographics
NPI:1821031592
Name:LEVINE, RICHARD B
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:B
Last Name:LEVINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4241 VETERANS BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-5430
Mailing Address - Country:US
Mailing Address - Phone:504-888-7921
Mailing Address - Fax:504-883-5384
Practice Address - Street 1:4241 VETERANS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006
Practice Address - Country:US
Practice Address - Phone:504-888-7921
Practice Address - Fax:504-883-5384
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10881R2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1982091Medicaid
LA10881ROtherMEDICAL LICENSE
LA5U136Medicare ID - Type Unspecified
LAA88876Medicare UPIN