Provider Demographics
NPI:1457344921
Name:LEVINE, JEFFREY HARRIS (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:HARRIS
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 1:401 42ND AVE NORTH
Mailing Address - Street 2:SUITE 400
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-1532
Mailing Address - Country:US
Mailing Address - Phone:615-329-7887
Mailing Address - Fax:615-340-4537
Practice Address - Street 1:660 S MOUNT JULIET RD STE 230
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-3923
Practice Address - Country:US
Practice Address - Phone:615-874-9667
Practice Address - Fax:615-871-9682
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN70706208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00025821201OtherUNIVERA
PA1508396OtherGATEWAY
PA0017599780004Medicaid
WV1068850OtherWEST VIRGINIA WORK COMP
PA119508OtherUNISON
PA2988615OtherAETNA
PA217386OtherUPMC
NY02166407OtherNY MEDICAL ASSISTANCE
PA612674OtherBLUESHIELD
PA020049122OtherRR MEDICARE
OH2248875OtherOH MEDICAL ASSISTANCE
PA217386OtherUPMC
PA612674OtherBLUESHIELD