Healthcare Provider Details

I. General information

NPI: 1477548410
Provider Name (Legal Business Name): MARVIN R LEVENTHAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 GREENBRIAR DR
MEMPHIS TN
38117-3207
US

IV. Provider business mailing address

151 GREENBRIAR DR
MEMPHIS TN
38117-3207
US

V. Phone/Fax

Practice location:
  • Phone: 901-641-3000
  • Fax:
Mailing address:
  • Phone: 901-359-5916
  • Fax: 901-359-5916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD0000014069
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number14069
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: