Provider Demographics
NPI:1780609750
Name:LEVY, LAWRENCE A (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:A
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 1:1300 S ELISEO DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2023
Mailing Address - Country:US
Mailing Address - Phone:415-925-3075
Mailing Address - Fax:415-925-3070
Practice Address - Street 1:1300 S ELISEO DR
Practice Address - Street 2:SUITE 104
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2023
Practice Address - Country:US
Practice Address - Phone:415-925-3075
Practice Address - Fax:415-925-3070
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG23281174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAYYY48869YMedicaid
CACS1662Medicare PIN
CA00G232810Medicare UPIN
CA110060792Medicare PIN
CAYYY48869YMedicaid
CAYYY48896YMedicare ID - Type Unspecified