MEDICARE: DR. RICHARD FREDERIC LEVY 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	208000000X	Pediatrics Physician	G24539	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	:	1376681445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD FREDERIC LEVY M.D.

Provider Business Mailing Address
First Line	:	1811 WILSHIRE BLVD STE 110
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-5626
Country	:	US
Telephone Number	:	310-453-9010
Fax Number	:

Provider Business Practice Location Address
First Line	:	934 21ST ST
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-3433
Country	:	US
Telephone Number	:	310-383-3297
Fax Number	:

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

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	08/24/2020

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