Healthcare Provider Details

I. General information

NPI: 1710429188
Provider Name (Legal Business Name): DANIEL J. LEVY, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2016
Last Update Date: 02/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10085 RED RUN BLVD SUITE 201
OWINGS MILLS MD
21117-4836
US

IV. Provider business mailing address

10085 RED RUN BLVD SUITE 201
OWINGS MILLS MD
21117-4836
US

V. Phone/Fax

Practice location:
  • Phone: 410-363-1843
  • Fax:
Mailing address:
  • Phone: 410-363-1843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DANIEL J LEVY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 410-363-1843