MEDICARE: DR. TEDD LEVIN M.D.

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	207QA0505X	Adult Medicine Physician	14616	OR
2	2083P0901X	Public Health & General Preventive Medicine Physician	14616	OR

General Provider Information

NPI Number	:	1598744971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TEDD LEVIN M.D.

Provider Business Mailing Address
First Line	:	32302 SE OXBOW DR
Second Line	:
City	:	GRESHAM
State	:	OR
Zip	:	97080-8954
Country	:	US
Telephone Number	:	503-663-5590
Fax Number	:	503-234-8928

Provider Business Practice Location Address
First Line	:	5919 SE BELMONT ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97215-1925
Country	:	US
Telephone Number	:	503-234-7366
Fax Number	:	503-234-8928

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

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	09/11/2025

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