Provider Demographics
NPI:1912030024
Name:DAVID J LEVINE DPM C PED
Entity Type:Organization
Organization Name:DAVID J LEVINE DPM C PED
Other - Org Name:DAVID J. LEVINE,D.P.M.,C.PED.,LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-696-0818
Mailing Address - Street 1:63 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4396
Mailing Address - Country:US
Mailing Address - Phone:301-696-0181
Mailing Address - Fax:301-696-8872
Practice Address - Street 1:63 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE C
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4384
Practice Address - Country:US
Practice Address - Phone:301-696-0181
Practice Address - Fax:301-696-8872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01018213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD480030842OtherMEDICARE RAILROAD
MD480030842OtherMEDICARE RAILROAD
MD594PMedicare PIN
MD0664390001Medicare NSC