MEDICARE: DR. SAMUEL DEWEY LEVANT MD

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
1	207W00000X	Ophthalmology Physician	DR.0077026	CO
2	390200000X	Student in an Organized Health Care Education/Training Program	0116036438	VA

General Provider Information

NPI Number	:	1548841612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL DEWEY LEVANT MD

Provider Business Mailing Address
First Line	:	1215 LEE ST BOX 800654
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22908-0816
Country	:	US
Telephone Number	:	434-924-5485
Fax Number	:	434-924-5180

Provider Business Practice Location Address
First Line	:	1215 LEE ST # 800654
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22908-0001
Country	:	US
Telephone Number	:	434-924-5485
Fax Number	:	434-924-5180

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2021
Last Update Date	:	03/02/2026

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