Healthcare Provider Details

I. General information

NPI: 1720339500
Provider Name (Legal Business Name): PATRICIA GAMEZ DE LEVY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2012
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST DEPT OF RADIOLOGY
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

22 S GREENE ST DEPT OF RADIOLOGY
BALTIMORE MD
21201-1544
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-3477
  • Fax:
Mailing address:
  • Phone: 410-328-3477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2012031850
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD82670
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: