Provider Demographics
NPI:1326019753
Name:LEVINE, MARISSA JANAE (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:JANAE
Last Name:LEVINE
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:DR
Other - First Name:MARK
Other - Middle Name:JEFFREY
Other - Last Name:LEVINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:109 GOVERNOR ST
Mailing Address - Street 2:13TH FLOOR
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-3623
Mailing Address - Country:US
Mailing Address - Phone:804-864-7009
Mailing Address - Fax:804-864-7022
Practice Address - Street 1:109 GOVERNOR ST
Practice Address - Street 2:13TH FLOOR
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-3623
Practice Address - Country:US
Practice Address - Phone:804-864-7009
Practice Address - Fax:804-864-7022
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101037650207Q00000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C33046Medicare UPIN