Provider Demographics
NPI:1528063567
Name:LEVIN, PHILIP A (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:A
Last Name:LEVIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6535 NORTH CHARLES STREET
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204
Mailing Address - Country:US
Mailing Address - Phone:410-828-7417
Mailing Address - Fax:410-828-4695
Practice Address - Street 1:6535 NORTH CHARLES STREET
Practice Address - Street 2:SUITE 400
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204
Practice Address - Country:US
Practice Address - Phone:410-828-7417
Practice Address - Fax:410-828-4695
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD18380174400000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD311551800Medicaid
MD271LMedicare ID - Type UnspecifiedMEDICARE
MDB32484Medicare UPIN
MD311551800Medicaid