Provider Demographics
NPI:1255429049
Name:LEVINE, CHARLES RAY (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:RAY
Last Name:LEVINE
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 1:450 CHEW STREET
Mailing Address - Street 2:THE SIGNAL CENTER
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102
Mailing Address - Country:US
Mailing Address - Phone:610-776-5477
Mailing Address - Fax:610-776-5479
Practice Address - Street 1:450 CHEW STREET
Practice Address - Street 2:THE SIGNAL CENTER
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102
Practice Address - Country:US
Practice Address - Phone:610-776-5477
Practice Address - Fax:610-776-5479
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD014412E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50000228OtherCAPITAL BLUE CROSS
PA079061OtherPA BLUE SHIELD
C29192Medicare UPIN
PA079061Medicare ID - Type Unspecified