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 1:6140 W ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-2855
Mailing Address - Country:US
Mailing Address - Phone:561-498-4407
Mailing Address - Fax:561-498-4480
Practice Address - Street 1:6140 W ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-2009
Practice Address - Country:US
Practice Address - Phone:561-498-4407
Practice Address - Fax:561-498-4407
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2024-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME147002207ND0101X, 207N00000X, 207NS0135X, 207N00000X
NV20282207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112900100Medicaid
FLME147002OtherFLORIDA LICENSE
FLME147002OtherFLORIDA LICENSE
CO35847OtherCO LICENSE