MEDICARE: DR. BRUCE ALAN LEVIN DPM

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	213E00000X	Podiatrist	SC001718L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	31774	OTHER	PA	KEYSTONE MERCY HLTH PLAN

General Provider Information

NPI Number	:	1710094750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE ALAN LEVIN DPM

Provider Business Mailing Address
First Line	:	105 RENNARD TERRACE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19116-2605
Country	:	US
Telephone Number	:	215-260-8654
Fax Number	:	215-969-6549

Provider Business Practice Location Address
First Line	:	410 E ROOSEVELT BLVD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19120-4011
Country	:	US
Telephone Number	:	215-260-8654
Fax Number	:	215-969-6549

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

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	07/08/2007

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