MEDICARE: REBECCA LEVY-GANTT D.O.

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	207V00000X	Obstetrics & Gynecology Physician	20A8707	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P724771	OTHER	NY	OXFORD
2	68I56	OTHER	NY	BLUE CROSS

General Provider Information

NPI Number	:	1528165263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA LEVY-GANTT D.O.

Provider Business Mailing Address
First Line	:	3030 BEARD RD
Second Line	:	STE C
City	:	NAPA
State	:	CA
Zip	:	94558-3490
Country	:	US
Telephone Number	:	707-681-1545
Fax Number	:

Provider Business Practice Location Address
First Line	:	3030 BEARD RD
Second Line	:	STE C
City	:	NAPA
State	:	CA
Zip	:	94558-3490
Country	:	US
Telephone Number	:	707-681-1545
Fax Number	:

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

Provider Enumeration Date	:	09/17/2006
Last Update Date	:	06/14/2014

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