Provider Demographics
NPI:1932108040
Name:LEVINE, DAVID JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JAY
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:19271 MONTGOMERY VILLAGE AVE
Mailing Address - Street 2:STE H-2
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-5021
Mailing Address - Country:US
Mailing Address - Phone:301-977-2300
Mailing Address - Fax:301-977-2348
Practice Address - Street 1:19271 MONTGOMERY VILLAGE AVE
Practice Address - Street 2:STE H-2
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886-5021
Practice Address - Country:US
Practice Address - Phone:301-977-2300
Practice Address - Fax:301-977-2348
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD18058207W00000X
DC7978207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LE177290Medicare ID - Type Unspecified
C88317Medicare UPIN