Provider Demographics
NPI:1700997988
Name:LEVINE, RICHARD G (MD, FAAD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:G
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD, FAAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5210 WEBB RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-4518
Mailing Address - Country:US
Mailing Address - Phone:813-882-9986
Mailing Address - Fax:813-341-3259
Practice Address - Street 1:6600 UNIVERSITY PKWY STE 302
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240-9048
Practice Address - Country:US
Practice Address - Phone:941-800-5001
Practice Address - Fax:941-800-5012
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20282207N00000X, 207ND0101X
FLME147002207ND0101X, 207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112900100Medicaid
NV20282OtherNV LICENSE
FLME147002OtherFLORIDA LICENSE
CO35847OtherCO LICENSE