Provider Demographics
NPI:1225004765
Name:LEVINE, STEVEN B (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:B
Last Name:LEVINE
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 1:54 MAIN ST STE 10
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02347-3622
Mailing Address - Country:US
Mailing Address - Phone:203-830-4700
Mailing Address - Fax:203-730-4165
Practice Address - Street 1:160 HAWLEY LN
Practice Address - Street 2:SUITE 202
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-5300
Practice Address - Country:US
Practice Address - Phone:203-380-3707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT027247207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT040000343Medicare ID - Type UnspecifiedMEDICARE
CTB39229Medicare UPIN