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NPI Code Detail

MEDICARE: DR. KENNETH M LEVY DO

MEDICARE: DR. KENNETH M LEVY DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0805XGeriatric Psychiatry Physician0S007464LPA

General Provider Information

NPI Number : 1457319550
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KENNETH M LEVY DO
Provider Business Mailing Address
First Line : 8400 ROOSEVELT BLVD
Second Line : STE 206
City : PHILADELPHIA
State : PA
Zip : 19152-2081
Country : US
Telephone Number : 215-333-7560
Fax Number : 215-333-7563
Provider Business Practice Location Address
First Line : 8400 ROOSEVELT BLVD
Second Line : STE 206
City : PHILADELPHIA
State : PA
Zip : 19152-2081
Country : US
Telephone Number : 215-333-7560
Fax Number : 215-333-7563
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2006
Last Update Date : 09/16/2013

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