=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689995433
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID J. LEVINE, M.D., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2010
-----------------------------------------------------
Last Update Date | 06/16/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19271 MONTGOMERY VILLAGE AVE SUITE H-2
-----------------------------------------------------
City | MONTGOMERY VILLAGE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20886-5021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-977-2300
-----------------------------------------------------
Fax | 301-977-2348
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19271 MONTGOMERY VILLAGE AVE SUITE H-2
-----------------------------------------------------
City | MONTGOMERY VILLAGE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20886-5021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-977-2300
-----------------------------------------------------
Fax | 301-977-2348
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DAVID JAY LEVINE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 301-977-2300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------