Healthcare Provider Details

I. General information

NPI: 1942703772
Provider Name (Legal Business Name): MADELYN REA LEVINE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2018
Last Update Date: 09/07/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4810 OLD WILLIAM PENN HWY STE 6
EXPORT PA
15632-9468
US

IV. Provider business mailing address

1247 S NEGLEY AVE
PITTSBURGH PA
15217-1218
US

V. Phone/Fax

Practice location:
  • Phone: 724-327-1122
  • Fax:
Mailing address:
  • Phone: 724-787-2054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2901600254
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2901022717
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2901022717
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS042564
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: