Provider Demographics
NPI:1104814821
Name:LEVY, MICHAEL STUART (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:STUART
Last Name:LEVY
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 MEADE ST
Mailing Address - Street 2:
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18512-3195
Mailing Address - Country:US
Mailing Address - Phone:570-288-3535
Mailing Address - Fax:570-288-0804
Practice Address - Street 1:1000 MEADE ST
Practice Address - Street 2:
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18512-3195
Practice Address - Country:US
Practice Address - Phone:570-288-3535
Practice Address - Fax:570-288-0804
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0S013340207X00000X, 207XX0801X
NJ25MB07763100207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
093500SPDOtherMEDICARE ID- TYPE UNSPECIFIED
NJ0219118Medicaid
NJ0219118Medicaid
I37686Medicare UPIN
093500SPDOtherMEDICARE ID- TYPE UNSPECIFIED