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NPI Code Detail

MEDICARE: MARK R LEVY MD

MEDICARE: MARK R LEVY MD
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
1207Q00000XFamily Medicine PhysicianMD00020970WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1L587OTHERWABLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
30039581OTHERWALABOR & INDUSTRY
4US4120494OTHERWAAETNA/USHC SPECIALIST

General Provider Information

NPI Number : 1235145186
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK R LEVY MD
Provider Business Mailing Address
First Line : 1100 9TH AVE
Second Line : MS:M4-PA
City : SEATTLE
State : WA
Zip : 98101-2756
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 100 NE GILMAN BLVD
Second Line :
City : ISSAQUAH
State : WA
Zip : 98027-2925
Country : US
Telephone Number : 425-557-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2006
Last Update Date : 09/14/2012

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