Healthcare Provider Details

I. General information

NPI: 1902022213
Provider Name (Legal Business Name): MARK DAVID LEVINE, MD TRACY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28465 S CHRISMAN RD
TRACY CA
95304-8101
US

IV. Provider business mailing address

3835 N FREEWAY BLVD 100
SACRAMENTO CA
95834-1928
US

V. Phone/Fax

Practice location:
  • Phone: 916-576-7898
  • Fax: 916-285-0338
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: PRESIDENT
Credential: MD
Phone: 916-576-7898