Provider Demographics
NPI:1952321085
Name:LEVSKY, MARC ELLIOTT (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:ELLIOTT
Last Name:LEVSKY
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 1:1900 SULLIVAN AVE
Mailing Address - Street 2:DEPT OF EMERGENCY MEDICINE
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2200
Mailing Address - Country:US
Mailing Address - Phone:659-991-6856
Mailing Address - Fax:
Practice Address - Street 1:1900 SULLIVAN AVE
Practice Address - Street 2:DEPT OF EMERGENCY MEDICINE
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2200
Practice Address - Country:US
Practice Address - Phone:659-991-6856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4856207P00000X
CAA100429207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183829402Medicaid
TX183829403OtherCSHCN
TX8S9957OtherBCBS
TX8V7087OtherBCBS
TX183829401Medicaid
TX183829404OtherCSHCN
TXP00375916Medicare PIN
TX183829401Medicaid
TX8J0508Medicare PIN
TX183829403OtherCSHCN