Provider Demographics
NPI:1700965050
Name:ADVANCED BAY AREA MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:ADVANCED BAY AREA MEDICAL ASSOCIATES
Other - Org Name:JEFFREY R LEVENSON MD PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-384-2479
Mailing Address - Street 1:1700 66TH ST N
Mailing Address - Street 2:SUITE# 510
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-5544
Mailing Address - Country:US
Mailing Address - Phone:727-384-2479
Mailing Address - Fax:727-384-3573
Practice Address - Street 1:1700 66TH ST N
Practice Address - Street 2:SUITE# 510
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-5544
Practice Address - Country:US
Practice Address - Phone:727-384-2479
Practice Address - Fax:727-384-3573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0055609174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257401200Medicaid