Provider Demographics
NPI:1962461202
Name:LEVITAN, RICHARD M (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:M
Last Name:LEVITAN
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:PO BOX 678
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03247-0678
Mailing Address - Country:US
Mailing Address - Phone:603-524-3211
Mailing Address - Fax:215-923-6225
Practice Address - Street 1:15 AIKEN AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NH
Practice Address - Zip Code:03235-1259
Practice Address - Country:US
Practice Address - Phone:603-934-2060
Practice Address - Fax:215-456-8502
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD058632L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001588674Medicaid
PA001588674Medicaid
867533Medicare ID - Type Unspecified