Provider Demographics
NPI:1336262492
Name:LEVIN, RONALD W (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:W
Last Name:LEVIN
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 1:4033 E MADISON ST
Mailing Address - Street 2:SUITE #110
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-3104
Mailing Address - Country:US
Mailing Address - Phone:206-323-3771
Mailing Address - Fax:206-324-3276
Practice Address - Street 1:4033 E MADISON ST
Practice Address - Street 2:SUITE #110
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-3104
Practice Address - Country:US
Practice Address - Phone:206-323-3771
Practice Address - Fax:206-324-3276
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000150702084P0015X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA103055OtherGROUP #
WA103055OtherGROUP #
WAL668Medicare ID - Type Unspecified