MEDICARE: MATTHEW R LEVIN AA-C

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	367H00000X	Anesthesiologist Assistant	67-000089	OH

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
2	000000334353	OTHER	OH	ANTHEM BCBS

General Provider Information

NPI Number	:	1770576605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW R LEVIN AA-C

Provider Business Mailing Address
First Line	:	19250 BAGLEY RD
Second Line	:	#101
City	:	CLEVELAND
State	:	OH
Zip	:	44130-3314
Country	:	US
Telephone Number	:	440-891-8800
Fax Number	:	440-891-1734

Provider Business Practice Location Address
First Line	:	29000 CENTER RIDGE RD
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-5293
Country	:	US
Telephone Number	:	440-827-5000
Fax Number	:

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

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	07/08/2007

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