Provider Demographics
NPI:1154365310
Name:OGLEVIE, STEVEN B (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:B
Last Name:OGLEVIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 SEABRIGHT PL
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-2126
Mailing Address - Country:US
Mailing Address - Phone:949-887-8304
Mailing Address - Fax:
Practice Address - Street 1:1460 SEABRIGHT PL
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-2126
Practice Address - Country:US
Practice Address - Phone:949-887-8304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA438612085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A438610OtherBLUE SHIELD
CA00A438610Medicaid
CA00A438610OtherBLUE SHIELD
CAWA43861HMedicare PIN
F41065Medicare UPIN
CAP00025618Medicare PIN
CAWA43861GMedicare PIN