Healthcare Provider Details

I. General information

NPI: 1780850339
Provider Name (Legal Business Name): REBECCA L. LEVY MED, CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 CENTREVILLE RD SUITE 400
CENTREVILLE VA
20121-2626
US

IV. Provider business mailing address

8316 ARLINGTON BLVD SUITE 300
FAIRFAX VA
22031-5207
US

V. Phone/Fax

Practice location:
  • Phone: 703-968-9087
  • Fax:
Mailing address:
  • Phone: 703-573-7600
  • Fax: 703-573-2694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2201001235
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: