Provider Demographics
NPI:1811095102
Name:LEVINE, RENEE A (MD)
Entity type:Individual
Prefix:DR
First Name:RENEE
Middle Name:A
Last Name:LEVINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4950 ESSEN LANE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3482
Mailing Address - Country:US
Mailing Address - Phone:225-215-1311
Mailing Address - Fax:225-215-1380
Practice Address - Street 1:4950 ESSEN LANE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3482
Practice Address - Country:US
Practice Address - Phone:225-767-0847
Practice Address - Fax:225-766-1417
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA10830R2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1993603Medicaid
LAF08241Medicare UPIN
LA5U4797290Medicare PIN