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General NPI Number Information
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NPI Number | 1679537674
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Entity Type | Individual
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Provider Name | EDGAR MORRIS LEVINE M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/14/2006
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Last Update Date | 08/14/2007
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Provider Practice Location Address
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Address Line | 620 JOHN PAUL JONES CIR DEPT OF OPHTHALMOLOGY
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City | PORTSMOUTH
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State | VA
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Zip | 23708-2111
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Country | US
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Telephone | 757-953-2691
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Fax | 757-953-0855
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Provider Business Mailing Address
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Address Line | 2712 NESTLEBROOK TRL
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City | VIRGINIA BEACH
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State | VA
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Zip | 23456-8309
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Country | US
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Telephone | 757-426-7644
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 0101231534
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License Number State | VA
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