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1295736429

NPI Code Detail

MEDICARE: DR. JERRY ISADORE LEVINE M.D.

MEDICARE: DR. JERRY ISADORE LEVINE M.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	207R00000X	Internal Medicine Physician	D0022856	MD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
8	110142478	OTHER	MD	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1865815	OTHER	MD	CIGNA PIN
2	4238661	OTHER	MD	AETNA FEE FOR SERVICE
3	3509-0004	OTHER	MD	CAREFIRST BLUECHOICE
4	843368	OTHER	MD	MAMSI PRIMARY CARE
5	243368	OTHER	MD	MAMSI SPECIALIST
6	020550	OTHER	MD	JHHC PROVIDER NUMBER
7	P12725	OTHER	MD	CAREFIRST MPOS
9	0477651	OTHER	MD	AETNA CAPITATED
10	366910-01	OTHER	MD	CAREFIRST MD RENDERING
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295736429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERRY ISADORE LEVINE M.D.

Provider Business Mailing Address
First Line	:	7580 BUCKINGHAM BLVD STE 20
Second Line	:
City	:	HANOVER
State	:	MD
Zip	:	21076-3208
Country	:	US
Telephone Number	:	410-729-5100
Fax Number	:

Provider Business Practice Location Address
First Line	:	5900 WATERLOO RD STE 200
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-2641
Country	:	US
Telephone Number	:	410-740-2900
Fax Number	:	410-992-0732

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	03/13/2023

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Directions to “ DR. JERRY ISADORE LEVINE M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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