Healthcare Provider Details

I. General information

NPI: 1427053834
Provider Name (Legal Business Name): ELIE LEVY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 06/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13610 1ST AVE S
BURIEN WA
98168-3404
US

IV. Provider business mailing address

13610 1ST AVE S
BURIEN WA
98168-3404
US

V. Phone/Fax

Practice location:
  • Phone: 206-248-5020
  • Fax: 206-244-8425
Mailing address:
  • Phone: 206-248-5020
  • Fax: 206-244-8425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberASF.FS.60099259
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberASF.FS.60099259
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD00000034385
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD00034385
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberMD00034385
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberMD00034385
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: