Provider Demographics
NPI:1396787552
Name:LEVINE, MATTHEW E (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:E
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3031 IH 10 W
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-5159
Mailing Address - Country:US
Mailing Address - Phone:210-731-1300
Mailing Address - Fax:210-738-8025
Practice Address - Street 1:1921 BURNET
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78202-2516
Practice Address - Country:US
Practice Address - Phone:210-731-1300
Practice Address - Fax:210-738-8025
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL33802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159953201Medicaid
B73486Medicare UPIN
TX159953201Medicaid