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General NPI Number Information
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NPI Number | 1053677690
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Entity Type | Individual
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Provider Name | LEONARD S LEVINE MD
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Gender | Male
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Dates
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Enumeration Date | 04/09/2012
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Last Update Date | 04/09/2012
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Provider Practice Location Address
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Address Line | 6205 MARILYN DR
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City | ALEXANDRIA
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State | VA
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Zip | 22310-1520
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Country | US
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Telephone | 703-971-3941
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Fax |
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Provider Business Mailing Address
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Address Line | 6205 MARILYN DR
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City | ALEXANDRIA
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State | VA
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Zip | 22310-1520
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Country | US
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Telephone | 703-971-3941
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | 0101016603
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License Number State | VA
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