Healthcare Provider Details

I. General information

NPI: 1114108768
Provider Name (Legal Business Name): SCOTT D LEVENSON, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2007
Last Update Date: 12/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 LAUREL ST
SAN CARLOS CA
94070-3939
US

IV. Provider business mailing address

PO BOX 7625
MENLO PARK CA
94026-7625
US

V. Phone/Fax

Practice location:
  • Phone: 650-596-8800
  • Fax: 650-596-8802
Mailing address:
  • Phone: 650-596-8800
  • Fax: 650-596-8802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA98824
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberG71807
License Number StateCA

VIII. Authorized Official

Name: SCOTT D LEVENSON
Title or Position: PRESIDENT
Credential: MD
Phone: 650-596-8800