Provider Demographics
NPI:1821199811
Name:LEVINSON, MARK BARRY (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:BARRY
Last Name:LEVINSON
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 1:1455 S POTOMAC ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4504
Mailing Address - Country:US
Mailing Address - Phone:303-755-2510
Mailing Address - Fax:303-695-8013
Practice Address - Street 1:1455 S POTOMAC ST
Practice Address - Street 2:SUITE 207
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4504
Practice Address - Country:US
Practice Address - Phone:303-755-2510
Practice Address - Fax:303-695-8013
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17539207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO2353261Medicare ID - Type Unspecified
COE06383Medicare UPIN