Provider Demographics
NPI:1912915299
Name:LEVIN, PHILIP A (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:A
Last Name:LEVIN
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 1:3020 SUNSET BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-3494
Mailing Address - Country:US
Mailing Address - Phone:803-798-7660
Mailing Address - Fax:803-932-9618
Practice Address - Street 1:3020 SUNSET BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3494
Practice Address - Country:US
Practice Address - Phone:803-798-7660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8541207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC085419Medicaid
SCD74128Medicare UPIN
SC8678Medicare PIN