Healthcare Provider Details

I. General information

NPI: 1184204455
Provider Name (Legal Business Name): JORDAN LEVINE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1838 GREENE TREE RD STE 460
BALTIMORE MD
21208-7113
US

IV. Provider business mailing address

10200 GRAND CENTRAL AVE STE 220
OWINGS MILLS MD
21117-4366
US

V. Phone/Fax

Practice location:
  • Phone: 410-581-1600
  • Fax: 410-581-1603
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberD0105879
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: