Provider Demographics
NPI:1184761983
Name:LEVINE, HENRY S (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:S
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1112 11TH STREET
Mailing Address - Street 2:301
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225
Mailing Address - Country:US
Mailing Address - Phone:360-671-0383
Mailing Address - Fax:360-756-8850
Practice Address - Street 1:1112 11TH STREET
Practice Address - Street 2:301
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225
Practice Address - Country:US
Practice Address - Phone:360-671-0383
Practice Address - Fax:360-756-8850
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2012-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD000134252084P0800X, 2084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA107476001OtherGROUP HEALTH COOPERTIVE
WA03490OtherREGENCE
WAA09470Medicare UPIN
WAAB21134Medicare ID - Type Unspecified