MEDICARE: GERALD J LEVANDOSKI 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	208200000X	Plastic Surgery Physician	MD034037E	PA

General Provider Information

NPI Number	:	1932192382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERALD J LEVANDOSKI MD

Provider Business Mailing Address
First Line	:	1516 WYOMING AVE
Second Line	:
City	:	FORTY FORT
State	:	PA
Zip	:	18704-4225
Country	:	US
Telephone Number	:	570-288-1600
Fax Number	:

Provider Business Practice Location Address
First Line	:	1516 WYOMING AVE
Second Line	:
City	:	FORTY FORT
State	:	PA
Zip	:	18704-4225
Country	:	US
Telephone Number	:	570-288-1600
Fax Number	:

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

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	07/27/2010

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