MEDICARE: SUSAN E 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	MD022930E	PA
2	2080P0006X	Developmental - Behavioral Pediatrics Physician	MD022930E	PA
3	2080P0008X	Pediatric Neurodevelopmental Disabilities Physician	MD022930E	PA

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952325052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN E LEVY M.D.

Provider Business Mailing Address
First Line	:	100 E PENN SQ
Second Line	:	9TH FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-3323
Country	:	US
Telephone Number	:	267-425-9258
Fax Number	:	267-425-9299

Provider Business Practice Location Address
First Line	:	3550 MARKET ST FL 3
Second Line	:	CHILDREN'S HOSPITAL OF PHILADELPHIA - CHILD DEVELOPMENT
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-3365
Country	:	US
Telephone Number	:	267-425-5200
Fax Number	:	267-426-0975

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	10/23/2014

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