Provider Demographics
NPI:1295736429
Name:LEVINE, JERRY ISADORE (MD)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:ISADORE
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7580 BUCKINGHAM BLVD STE 20
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-3208
Mailing Address - Country:US
Mailing Address - Phone:410-729-5100
Mailing Address - Fax:
Practice Address - Street 1:5900 WATERLOO RD STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2641
Practice Address - Country:US
Practice Address - Phone:410-740-2900
Practice Address - Fax:410-992-0732
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0022856207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1865815OtherCIGNA PIN
MD4238661OtherAETNA FEE FOR SERVICE
MD3509-0004OtherCAREFIRST BLUECHOICE
MD843368OtherMAMSI PRIMARY CARE
MD243368OtherMAMSI SPECIALIST
MD020550OtherJHHC PROVIDER NUMBER
MDP12725OtherCAREFIRST MPOS
MD110142478OtherRR MEDICARE
MD0477651OtherAETNA CAPITATED
MD366910-01OtherCAREFIRST MD RENDERING
MD780581100Medicaid
MD843368OtherMAMSI PRIMARY CARE
MD020550OtherJHHC PROVIDER NUMBER