Provider Demographics
NPI:1245267798
Name:LEVINSON, BRETT ADAM (MD)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:ADAM
Last Name:LEVINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 VILLAGE SQ
Mailing Address - Street 2:SUITE 190
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-1602
Mailing Address - Country:US
Mailing Address - Phone:410-435-8881
Mailing Address - Fax:410-435-8886
Practice Address - Street 1:1 VILLAGE SQ
Practice Address - Street 2:SUITE 190
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-1602
Practice Address - Country:US
Practice Address - Phone:410-435-8881
Practice Address - Fax:410-435-8886
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0065684207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD9600064OtherAETNA
MD20714400Medicaid
MD146575YF38OtherMEDICARE PTAN
MD20714400Medicaid