Provider Demographics
NPI:1952406688
Name:LEVENSON, DEBORAH E (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:E
Last Name:LEVENSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418-1328
Mailing Address - Country:US
Mailing Address - Phone:203-732-1330
Mailing Address - Fax:203-732-1332
Practice Address - Street 1:22 WESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:ANSONIA
Practice Address - State:CT
Practice Address - Zip Code:06401-1158
Practice Address - Country:US
Practice Address - Phone:203-736-9919
Practice Address - Fax:855-212-4728
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT54945207RG0100X
NC2008-000387207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2008-000387OtherNC LICENSE
NC2022544AMedicare UPIN