Provider Demographics
NPI:1770810822
Name:LEVY, AARON DAVID (IDC)
Entity type:Individual
Prefix:MR
First Name:AARON
Middle Name:DAVID
Last Name:LEVY
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NAVAL UNDERSEA MEDICAL INSTITUTE 159 TROUT AVE
Mailing Address - Street 2:NAVSUBASE NLON
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06349-5159
Mailing Address - Country:US
Mailing Address - Phone:860-694-2876
Mailing Address - Fax:860-694-3874
Practice Address - Street 1:NAVAL UNDERSEA MEDICAL INSTITUTE 159 TROUT AVE
Practice Address - Street 2:NAVSUBASE NLON
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06349-5159
Practice Address - Country:US
Practice Address - Phone:860-694-2876
Practice Address - Fax:860-694-3874
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1710I1002X
CT69696969691710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1710I1002XOtherIDC