=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437591476
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRUCE J. LEVIN MD LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2013
-----------------------------------------------------
Last Update Date | 07/18/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 W GERMANTOWN PIKE
-----------------------------------------------------
City | PLYMOUTH MEETING
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19462-1435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-825-8501
-----------------------------------------------------
Fax | 610-825-8640
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 W GERMANTOWN PIKE
-----------------------------------------------------
City | PLYMOUTH MEETING
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19462-1435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-825-8501
-----------------------------------------------------
Fax | 610-825-8640
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE MEMBER
-----------------------------------------------------
Name | DR. BRUCE J LEVIN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 610-825-8501
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | MD032467E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------