Healthcare Provider Details

I. General information

NPI: 1568457166
Provider Name (Legal Business Name): ROBERT E LEVIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 BOSTON POST RD SUITE 5
EAST LYME CT
06333-1605
US

IV. Provider business mailing address

131 BOSTON POST RD P.O. BOX 490
EAST LYME CT
06333-1605
US

V. Phone/Fax

Practice location:
  • Phone: 860-691-1044
  • Fax: 860-691-1050
Mailing address:
  • Phone: 860-691-1044
  • Fax: 860-691-1050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number023047
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: