Provider Demographics
NPI:1649246703
Name:LEVINE, MARK
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:LEVINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3226 CHESTNUT ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-1412
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:ROOM 4D 52 MSC1372 BLDG 10
Practice Address - Street 2:10 CENTER DRIVE, NIH
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-1372
Practice Address - Country:US
Practice Address - Phone:301-402-5588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0023020174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist