Provider Demographics
NPI:1699712182
Name:LEVISOHN, DIANNE R (MD)
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:R
Last Name:LEVISOHN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19917 7TH AVE NE
Mailing Address - Street 2:STE 203
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-6555
Mailing Address - Country:US
Mailing Address - Phone:360-824-5474
Mailing Address - Fax:360-326-2451
Practice Address - Street 1:19917 7TH AVE NE
Practice Address - Street 2:STE 203
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-6555
Practice Address - Country:US
Practice Address - Phone:360-824-5474
Practice Address - Fax:360-326-2451
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00030159207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
070004630OtherRAILROAD MEDICARE
5395002OtherAETNA
WAG8950076OtherWEST SOUND DERM PTAN
LE7554OtherREGENCE BLUE SHIELD
WA30262OtherLABOR & INDUSTRIES
WA8142234Medicaid
WA8142234Medicaid
A13967Medicare UPIN
WAG8950076OtherWEST SOUND DERM PTAN
WAG8851918Medicare PIN
G8879278Medicare PIN
WAG000250424Medicare PIN
070004630OtherRAILROAD MEDICARE
WAG000250704Medicare PIN
WAG115136429Medicare PIN