Provider Demographics
NPI:1649254566
Name:LEVINSON, PAUL D (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:D
Last Name:LEVINSON
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 1:110 ELM ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4626
Mailing Address - Country:US
Mailing Address - Phone:401-649-4090
Mailing Address - Fax:401-649-4091
Practice Address - Street 1:375 WAMPANOAG TRL STE 202B
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-2234
Practice Address - Country:US
Practice Address - Phone:401-649-4090
Practice Address - Fax:401-649-4091
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD06526207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI007061092OtherMEDICARE PTAN
RI9006261Medicaid
MA110087950AMedicaid
MA110087950AMedicaid