Provider Demographics
NPI:1215780317
Name:LEVINE, MIA LI (DO)
Entity type:Individual
Prefix:DR
First Name:MIA
Middle Name:LI
Last Name:LEVINE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3350 HAUCK ST APT 2029
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-8034
Mailing Address - Country:US
Mailing Address - Phone:410-562-7877
Mailing Address - Fax:
Practice Address - Street 1:3900 SIERRA CIR
Practice Address - Street 2:
Practice Address - City:CENTER VALLEY
Practice Address - State:PA
Practice Address - Zip Code:18034-8471
Practice Address - Country:US
Practice Address - Phone:610-402-2277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAAA00052800202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry