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General NPI Number Information
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NPI Number | 1396278214
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Entity Type | Individual
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Provider Name | MARISSA GLORIA LEVINE D.O.
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Gender | Female
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Dates
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Enumeration Date | 04/07/2017
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 2655 RIDGEWAY AVE STE 180
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City | ROCHESTER
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State | NY
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Zip | 14626-4296
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Country | US
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Telephone | 585-368-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 100 KINGS HWY S
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City | ROCHESTER
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State | NY
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Zip | 14617-5504
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Country | US
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Telephone |
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 34.014308
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 334404
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License Number State | NY
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