Healthcare Provider Details

I. General information

NPI: 1104061712
Provider Name (Legal Business Name): MARK DAVID LEVINE, MD, CONCORD PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2008
Last Update Date: 04/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2485 HIGH SCHOOL AVE STE 218
CONCORD CA
94520-1819
US

IV. Provider business mailing address

2081 ARENA BLVD STE 160
SACRAMENTO CA
95834
US

V. Phone/Fax

Practice location:
  • Phone: 925-356-0561
  • Fax: 925-556-0485
Mailing address:
  • Phone: 916-576-7898
  • Fax: 916-285-0338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK DAVID LEVINE
Title or Position: OWNER
Credential: MD
Phone: 925-356-0561