Provider Demographics
NPI:1821319187
Name:JEROME S LITVINOFF MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:JEROME S LITVINOFF MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:LITVINOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-583-1200
Mailing Address - Street 1:6536 CRYSTALAIRE DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-3902
Mailing Address - Country:US
Mailing Address - Phone:619-583-1200
Mailing Address - Fax:619-583-8903
Practice Address - Street 1:6536 CRYSTALAIRE DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-3902
Practice Address - Country:US
Practice Address - Phone:619-583-1200
Practice Address - Fax:619-583-8903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A90628Medicare UPIN