Provider Demographics
NPI: | 1306880711 |
---|---|
Name: | LEVY, HOWARD (MD, PHD) |
Entity type: | Individual |
Prefix: | |
First Name: | HOWARD |
Middle Name: | |
Last Name: | LEVY |
Suffix: | |
Gender: | M |
Credentials: | MD, PHD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 7580 BUCKINGHAM BLVD STE 220 |
Mailing Address - Street 2: | |
Mailing Address - City: | HANOVER |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 21076-3210 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 410-729-5100 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 7580 BUCKINGHAM BLVD STE 220 |
Practice Address - Street 2: | |
Practice Address - City: | HANOVER |
Practice Address - State: | MD |
Practice Address - Zip Code: | 21076-3210 |
Practice Address - Country: | US |
Practice Address - Phone: | 410-729-3264 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-06-15 |
Last Update Date: | 2024-03-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MD | D48261 | 207R00000X, 207SG0201X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207SG0201X | Allopathic & Osteopathic Physicians | Medical Genetics | Clinical Genetics (M.D.) |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MD | 090802900 | Medicaid | |
MD | G45627 | Medicare UPIN | |
MD | KR6441HH | Medicare PIN | |
MD | KR47K329 | Medicare PIN |