Healthcare Provider Details

I. General information

NPI: 1942105960
Provider Name (Legal Business Name): JOHNETTE LEVI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13214 WATER FOWL WAY
UPPER MARLBORO MD
20774-7041
US

IV. Provider business mailing address

13214 WATER FOWL WAY
UPPER MARLBORO MD
20774-7041
US

V. Phone/Fax

Practice location:
  • Phone: 301-532-7473
  • Fax:
Mailing address:
  • Phone: 301-532-7473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberRN500339944
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: