Provider Demographics
NPI:1134123029
Name:LEVINE, DAVID JULIUS (DPM)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JULIUS
Last Name:LEVINE
Suffix:
Gender:M
Credentials:DPM
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 825159
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-5159
Mailing Address - Country:US
Mailing Address - Phone:314-909-1920
Mailing Address - Fax:855-495-2106
Practice Address - Street 1:63 THOMAS JOHNSON DR STE C
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4396
Practice Address - Country:US
Practice Address - Phone:301-696-0818
Practice Address - Fax:301-696-8872
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01018213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD545098500Medicaid
MD545098500Medicaid
MD549PMedicare PIN