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General NPI Number Information
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NPI Number | 1235355694
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Entity Type | Organization
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Legal Business Name | MARK DAVID LEVINE, MD MENLO PARK PC
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1600 ADAMS DR
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City | MENLO PARK
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State | CA
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Zip | 94025-1449
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Country | US
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Telephone | 650-688-5890
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Fax | 650-688-5891
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Provider Business Mailing Address
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Address Line | 4626 2ND ST 101
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City | DAVIS
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State | CA
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Zip | 95616-9446
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Country | US
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Telephone | 530-747-2022
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Fax | 530-747-2029
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK DAVID LEVINE
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Credential | MD
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Telephone | 415-479-2960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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