Provider Demographics
NPI:1528162716
Name:LEVINSON, LAWRENCE STEVEN (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:STEVEN
Last Name:LEVINSON
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:PO BOX 334
Mailing Address - Street 2:
Mailing Address - City:TIPTON
Mailing Address - State:PA
Mailing Address - Zip Code:16684-0334
Mailing Address - Country:US
Mailing Address - Phone:814-684-4600
Mailing Address - Fax:814-684-5557
Practice Address - Street 1:OLD RT 220
Practice Address - Street 2:BOX 334
Practice Address - City:TIPTON
Practice Address - State:PA
Practice Address - Zip Code:16684-0334
Practice Address - Country:US
Practice Address - Phone:814-684-4600
Practice Address - Fax:814-684-5557
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030356E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1239600Medicaid
412274Medicare ID - Type Unspecified
PA1239600Medicaid