Healthcare Provider Details

I. General information

NPI: 1710076526
Provider Name (Legal Business Name): HEATHER A. LEVENS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2978
US

IV. Provider business mailing address

PO BOX 744785
ATLANTA GA
30374-4785
US

V. Phone/Fax

Practice location:
  • Phone: 202-884-2182
  • Fax:
Mailing address:
  • Phone: 301-572-3500
  • Fax: 301-572-3544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD35628
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: