Healthcare Provider Details

I. General information

NPI: 1851372072
Provider Name (Legal Business Name): EDWARD A LEVY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 03/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33100 CLEVELAND CLINIC BLVD MAIL CODE AVW3-1
AVON OH
44011-1390
US

IV. Provider business mailing address

31699 TRADEWINDS DR
AVON LAKE OH
44012-2930
US

V. Phone/Fax

Practice location:
  • Phone: 440-695-4000
  • Fax: 440-695-4389
Mailing address:
  • Phone: 216-702-2315
  • Fax: 440-695-4389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number35-063360
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number35-063360
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: