Provider Demographics
NPI:1487696431
Name:LEVIN, RICHARD A (MD, DMD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:LEVIN
Suffix:
Gender:M
Credentials:MD, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 POST RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6016
Mailing Address - Country:US
Mailing Address - Phone:203-259-4700
Mailing Address - Fax:203-259-0328
Practice Address - Street 1:1305 POST RD
Practice Address - Street 2:SUITE 302
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6016
Practice Address - Country:US
Practice Address - Phone:203-259-4700
Practice Address - Fax:203-259-0328
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT032601207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010032601CT01OtherBLUE CROSS BLUE SHIELD
CT0147826015OtherCIGNA
CTP2711818OtherOXFORD
CT2V2098OtherPHS
CT001326017Medicaid
CT532601OtherCONNECTICARE
CT550789127OtherTAX ID
CT2970623OtherAETNA
CT550789127OtherTAX ID
CT0147826015OtherCIGNA