Provider Demographics
NPI:1972815504
Name:GERALD A LEVINE MD INC
Entity Type:Organization
Organization Name:GERALD A LEVINE MD INC
Other - Org Name:GERALD A. LEVINE M.D. A MEDICAL CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEVINE MD A MEDICAL CORPORATION
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-453-0559
Mailing Address - Street 1:2001 SANTA MONICA BLVD STE 390W
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2207
Mailing Address - Country:US
Mailing Address - Phone:310-453-0559
Mailing Address - Fax:310-453-4770
Practice Address - Street 1:2001 SANTA MONICA BLVD STE 390W
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2207
Practice Address - Country:US
Practice Address - Phone:310-453-0559
Practice Address - Fax:310-453-4770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-12
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty