Provider Demographics
NPI:1275639080
Name:LEVOS, JAMES EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:LEVOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:686 S PIKE ST
Mailing Address - Street 2:STE A
Mailing Address - City:SHINNSTON
Mailing Address - State:WV
Mailing Address - Zip Code:26431-1043
Mailing Address - Country:US
Mailing Address - Phone:304-624-4655
Mailing Address - Fax:304-624-3918
Practice Address - Street 1:21 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:PENNSBORO
Practice Address - State:WV
Practice Address - Zip Code:26415-1276
Practice Address - Country:US
Practice Address - Phone:304-659-2986
Practice Address - Fax:304-659-2988
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV12064207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1806310000Medicaid
A72058Medicare UPIN
WV0469928Medicare PIN
WV0469927Medicare PIN
WV0469929Medicare PIN
WV1806310000Medicaid