Provider Demographics
NPI:1841222577
Name:LEVA, PAUL R (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:R
Last Name:LEVA
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 1:320 LAUREL RD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-3138
Mailing Address - Country:US
Mailing Address - Phone:631-261-0158
Mailing Address - Fax:631-261-0296
Practice Address - Street 1:320 LAUREL RD
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-3138
Practice Address - Country:US
Practice Address - Phone:631-261-0158
Practice Address - Fax:631-261-0296
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY173118207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000000059073OtherGHI HMO
NY173118OtherHIP
NY5352101OtherAETNA PPO
NY0088949OtherGHI PPO
NY0P4162OtherEMPIRE BCBS OF NY
NY2C7927OtherHEALTHNET
NYCG6264OtherRAILROAD MEDICARE
NY01065030Medicaid
NY0462576OtherAETNA HMO
NY17E412OtherEMPIRE BCBS OF NY
NYCG6265OtherRAILROAD MEDICARE
NYP378023OtherOXFORD
NY0462576OtherAETNA HMO
NY000000059073OtherGHI HMO
NYCG6265OtherRAILROAD MEDICARE
NY5352101OtherAETNA PPO
NY17E41ZT3Y1Medicare PIN