Provider Demographics
NPI:1932176849
Name:LEVINE, ZACHARY T (MD)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:T
Last Name:LEVINE
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 1:4927 AUBURN AVE
Mailing Address - Street 2:STE T50
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814
Mailing Address - Country:US
Mailing Address - Phone:301-718-9611
Mailing Address - Fax:301-718-2979
Practice Address - Street 1:4927 AUBURN AVE
Practice Address - Street 2:STE T50
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814
Practice Address - Country:US
Practice Address - Phone:301-718-9611
Practice Address - Fax:301-718-2979
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD55620207T00000X
DC30223207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
005112N17Medicare ID - Type Unspecified
H12695Medicare UPIN