Provider Demographics
NPI:1902022213
Name:MARK DAVID LEVINE, MD TRACY PC
Entity Type:Organization
Organization Name:MARK DAVID LEVINE, MD TRACY PC
Other - Org Name:COMMUNITY PSYCHIATRY ASSOCIATES, TRACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-576-7898
Mailing Address - Street 1:3835 N FREEWAY BLVD
Mailing Address - Street 2:100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1928
Mailing Address - Country:US
Mailing Address - Phone:916-576-7898
Mailing Address - Fax:916-285-0338
Practice Address - Street 1:28465 S CHRISMAN RD
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95304-8101
Practice Address - Country:US
Practice Address - Phone:916-576-7898
Practice Address - Fax:916-285-0338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty