Provider Demographics
NPI:1831136365
Name:CHARLES T LEVITAN MD INC
Entity Type:Organization
Organization Name:CHARLES T LEVITAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:T
Authorized Official - Last Name:LEVITAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-539-2912
Mailing Address - Street 1:729 E CHAPMAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866
Mailing Address - Country:US
Mailing Address - Phone:714-539-2912
Mailing Address - Fax:714-997-9333
Practice Address - Street 1:729 E CHAPMAN AVENUE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866
Practice Address - Country:US
Practice Address - Phone:714-539-2912
Practice Address - Fax:714-997-9333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG25942207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G259423Medicaid
CAA42845Medicare UPIN
CA00G259423Medicaid