MEDICARE: TERRY B LEVENSON 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	207V00000X	Obstetrics & Gynecology Physician	09347	SC

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	621213	OTHER	SC	FIRST CHOICE IDENTIFIER

General Provider Information

NPI Number	:	1902869696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRY B LEVENSON MD

Provider Business Mailing Address
First Line	:	PO BOX 2180
Second Line	:
City	:	CONWAY
State	:	SC
Zip	:	29528-2180
Country	:	US
Telephone Number	:	843-347-7216
Fax Number	:	843-234-6990

Provider Business Practice Location Address
First Line	:	8004 MYRTLE TRACE DR
Second Line	:
City	:	CONWAY
State	:	SC
Zip	:	29526-8945
Country	:	US
Telephone Number	:	843-347-7216
Fax Number	:	843-347-7218

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

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	10/04/2016

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