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General NPI Number Information
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NPI Number | 1710094750
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Entity Type | Individual
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Provider Name | BRUCE ALAN LEVIN DPM
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Gender | Male
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Dates
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Enumeration Date | 08/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 410 E ROOSEVELT BLVD
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City | PHILADELPHIA
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State | PA
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Zip | 19120-4011
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Country | US
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Telephone | 215-260-8654
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Fax | 215-969-6549
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Provider Business Mailing Address
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Address Line | 105 RENNARD TERRACE
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City | PHILADELPHIA
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State | PA
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Zip | 19116-2605
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Country | US
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Telephone | 215-260-8654
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Fax | 215-969-6549
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | SC001718L
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License Number State | PA
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