Provider Demographics
NPI:1821051194
Name:LEVIN, BETH EZZELL (MD)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:EZZELL
Last Name:LEVIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:ANN
Other - Last Name:EZZELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:EVMS MEDICAL GROUP
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-7900
Mailing Address - Fax:757-446-8907
Practice Address - Street 1:825 FAIRFAX AVE STE 310
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-7900
Practice Address - Fax:757-446-8907
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047397207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAPAROtherUSA MANAGED CARE
VA-010OtherTRICARE/CHAMPUS
VA1821051194Medicaid
VA524155OtherANTHEM BC/BS
VA1821051194OtherVIRGINIA HEALTH NETWORK
NC1821051194Medicaid
VAPAROtherMULTIPLAN
VA1821051194OtherCOVENTRY NETWORK
VAPAROtherAETNA
VA1821051194OtherVIRGINIA PREMIER HEALTH PLAN
VA1821051194OtherUNITED HEALTHCARE
VA1821051194OtherCIGNA
VAPAROtherCORVEL
VA10133325OtherOPTIMA HEALTH
VAPAROtherAETNA