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NPI Code Detail

MEDICARE: MARK DAVID LEVINE, MD TRACY PC

MEDICARE: MARK DAVID LEVINE, MD TRACY PC
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
12084P0800XPsychiatry Physician

General Provider Information

NPI Number : 1902022213
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARK DAVID LEVINE, MD TRACY PC
Provider Business Mailing Address
First Line : 3835 N FREEWAY BLVD
Second Line : 100
City : SACRAMENTO
State : CA
Zip : 95834-1928
Country : US
Telephone Number : 916-576-7898
Fax Number : 916-285-0338
Provider Business Practice Location Address
First Line : 28465 S CHRISMAN RD
Second Line :
City : TRACY
State : CA
Zip : 95304-8101
Country : US
Telephone Number : 916-576-7898
Fax Number : 916-285-0338
Authorized Official
Title or Position : PRESIDENT
Name : DR. MARK DAVID LEVINE
Credential : MD
Telephone Number : 916-576-7898
Provider Enumeration Date : 04/17/2007
Last Update Date : 10/13/2015

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