Provider Demographics
NPI:1972731362
Name:MARK DAVID LEVINE MD REDDING PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MARK DAVID LEVINE MD REDDING PROFESSIONAL CORPORATION
Other - Org Name:COMMUNITY PSYCHIATRY ASSOCIATES REDDING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-576-7898
Mailing Address - Street 1:3841 N FREEWAY BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1949
Mailing Address - Country:US
Mailing Address - Phone:916-576-7898
Mailing Address - Fax:916-285-0338
Practice Address - Street 1:3 GOVERNORS LN
Practice Address - Street 2:SUITE B
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-5503
Practice Address - Country:US
Practice Address - Phone:530-838-4183
Practice Address - Fax:530-838-4394
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARK DAVID LEVINE MD PROFESSIONAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-24
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty