MEDICARE: DR. MIA LI LEVINE DO

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	2084P0800X	Psychiatry Physician	AA0005280020	PA

General Provider Information

NPI Number	:	1215780317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIA LI LEVINE DO

Provider Business Mailing Address
First Line	:	3350 HAUCK ST APT 2029
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-8034
Country	:	US
Telephone Number	:	410-562-7877
Fax Number	:

Provider Business Practice Location Address
First Line	:	3900 SIERRA CIR
Second Line	:
City	:	CENTER VALLEY
State	:	PA
Zip	:	18034-8471
Country	:	US
Telephone Number	:	610-402-2277
Fax Number	:

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

Provider Enumeration Date	:	04/09/2024
Last Update Date	:	04/09/2024

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