Healthcare Provider Details

I. General information

NPI: 1891980710
Provider Name (Legal Business Name): HAROLD D LEVY MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 09/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 MONTOWESE ST
BRANFORD CT
06405
US

IV. Provider business mailing address

140 MONTOWESE ST
BRANFORD CT
06405
US

V. Phone/Fax

Practice location:
  • Phone: 203-488-7248
  • Fax: 203-483-1222
Mailing address:
  • Phone: 203-488-7248
  • Fax: 203-483-1222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10370
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number10370
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number10370
License Number StateCT

VIII. Authorized Official

Name: HAROLD DAVID LEVY
Title or Position: PRESIDENT
Credential: MD
Phone: 203-488-7248