MEDICARE: FRED LEVINE M.D., PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207SG0201X	Clinical Genetics (M.D.) Physician	G65341	CA
2	207SG0202X	Clinical Biochemical Genetics Physician	G65341	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154493476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRED LEVINE M.D., PH.D.

Provider Business Mailing Address
First Line	:	3020 CHILDRENS WAY
Second Line	:	MC5110
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-4223
Country	:	US
Telephone Number	:	619-543-7800
Fax Number	:

Provider Business Practice Location Address
First Line	:	7910 FROST ST
Second Line	:	STE 200
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-2771
Country	:	US
Telephone Number	:	619-543-7800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	05/09/2014

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Directions to “ FRED LEVINE M.D., PH.D.” Practice Location

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