Healthcare Provider Details

I. General information

NPI: 1578548186
Provider Name (Legal Business Name): SCOTT DAVID LEVENSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 12/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 LAUREL ST
SAN CARLOS CA
94070-3919
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 TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberG071807
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License NumberG71807
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: