Provider Demographics
NPI:1972574010
Name:LEVINE, ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4717 S SUGAR RD
Mailing Address - Street 2:STE. H
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-7012
Mailing Address - Country:US
Mailing Address - Phone:956-383-4041
Mailing Address - Fax:956-383-4183
Practice Address - Street 1:4717 S SUGAR RD
Practice Address - Street 2:STE. H
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-7012
Practice Address - Country:US
Practice Address - Phone:956-383-4041
Practice Address - Fax:956-383-4183
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK4124207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX031009605Medicaid
TXK4124OtherMEDICAL LICENSE
TX031009601Medicaid
TXP00309343OtherPALMETTO
TX8AU910OtherBLUE CROSS BLUE SHIELD
TX8F3723Medicare PIN
TX8F2933Medicare PIN
TX00732DMedicare PIN
TXK4124OtherMEDICAL LICENSE