Provider Demographics
NPI:1427053834
Name:LEVY, ELIE (MD)
Entity type:Individual
Prefix:DR
First Name:ELIE
Middle Name:
Last Name:LEVY
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 1:13610 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98168-3404
Mailing Address - Country:US
Mailing Address - Phone:206-248-5020
Mailing Address - Fax:206-244-8425
Practice Address - Street 1:13610 1ST AVE S
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98168-3404
Practice Address - Country:US
Practice Address - Phone:206-248-5020
Practice Address - Fax:206-244-8425
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00000034385174400000X
WAASF.FS.60099259261QA1903X, 261Q00000X
WAMD00034385207N00000X, 207ND0101X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7089576Medicaid
WAG8804525Medicare ID - Type Unspecified
WA7089576Medicaid