Healthcare Provider Details

I. General information

NPI: 1275853590
Provider Name (Legal Business Name): DAVID A LEVINE M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

4957 38TH AVE N SUITE B
ST PETERSBURG FL
33710-2174
US

IV. Provider business mailing address

4957 38TH AVE N SUITE B
ST PETERSBURG FL
33710-2174
US

V. Phone/Fax

Practice location:
  • Phone: 727-522-8878
  • Fax: 727-521-1192
Mailing address:
  • Phone: 727-522-8878
  • Fax: 727-521-1192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberME51828
License Number StateFL

VIII. Authorized Official

Name: DAVID A LEVINE
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 727-522-8878