Provider Demographics
NPI:1215934286
Name:LEVINE, DONALD STUART (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:STUART
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3648
Mailing Address - Country:US
Mailing Address - Phone:860-358-6878
Mailing Address - Fax:860-358-4652
Practice Address - Street 1:80 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3648
Practice Address - Country:US
Practice Address - Phone:860-358-6878
Practice Address - Fax:860-358-4652
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA52691207R00000X, 207RE0101X
FLME54648207R00000X, 207RE0101X
CT022725207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6188346Medicaid
MA9707361Medicaid
MA6188346Medicaid
MA9707361Medicaid