Provider Demographics
NPI:1649334079
Name:LEVY, MATTHEW TOD (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:TOD
Last Name:LEVY
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 1:2350 W. EL CAMINO REAL
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-6203
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2581 SAMARITAN DRIVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4112
Practice Address - Country:US
Practice Address - Phone:408-358-3939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61490207RC0000X
CAA061490207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA61490OtherMCA MEDICAL LIC
CA26-3374042OtherTAX ID
CAH37434Medicare UPIN