Provider Demographics
NPI:1528056165
Name:LEVIN, BRUCE H (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:H
Last Name:LEVIN
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 1:3 N 2ND ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-2208
Mailing Address - Country:US
Mailing Address - Phone:215-776-6404
Mailing Address - Fax:215-922-0210
Practice Address - Street 1:3 N 2ND ST
Practice Address - Street 2:SUITE 3
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-2208
Practice Address - Country:US
Practice Address - Phone:215-776-6404
Practice Address - Fax:215-922-0210
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041591E207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE87942Medicare UPIN
PA529800H12Medicare PIN