Provider Demographics
NPI:1851372072
Name:LEVY, EDWARD A (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:A
Last Name:LEVY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:31699 TRADEWINDS DR
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-2930
Mailing Address - Country:US
Mailing Address - Phone:216-702-2315
Mailing Address - Fax:440-695-4389
Practice Address - Street 1:33100 CLEVELAND CLINIC BLVD
Practice Address - Street 2:MAIL CODE AVW3-1
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-1390
Practice Address - Country:US
Practice Address - Phone:440-695-4000
Practice Address - Fax:440-695-4389
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35-063360208200000X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341775196-00OtherBWC
OH0975477Medicaid
OH341775196-00OtherBWC
OH0975477Medicaid