Provider Demographics
NPI:1306966361
Name:LEVY, HOWARD R (DO)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:R
Last Name:LEVY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5965 CHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-5517
Mailing Address - Country:US
Mailing Address - Phone:215-727-2442
Mailing Address - Fax:215-727-8070
Practice Address - Street 1:5965 CHESTER AVE
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19143-5517
Practice Address - Country:US
Practice Address - Phone:215-727-2442
Practice Address - Fax:215-727-8070
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS002557L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006192010002Medicaid
PA0006192010002Medicaid