Healthcare Provider Details

I. General information

NPI: 1306821855
Provider Name (Legal Business Name): SUSAN L LEVY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2434 W BELVEDERE AVE
BALTIMORE MD
21215-5202
US

IV. Provider business mailing address

2434 W BELVEDERE AVE
BALTIMORE MD
21215-5202
US

V. Phone/Fax

Practice location:
  • Phone: 410-601-2246
  • Fax:
Mailing address:
  • Phone: 410-601-2246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberD33943
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberD0033943
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: