Provider Demographics
NPI:1699894972
Name:LEVINE, MICHAEL JESSE (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JESSE
Last Name:LEVINE
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Gender:M
Credentials:MD, MPH
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4374 NEW TOWN AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-2865
Mailing Address - Country:US
Mailing Address - Phone:757-259-1900
Mailing Address - Fax:757-259-1901
Practice Address - Street 1:4374 NEW TOWN AVE
Practice Address - Street 2:STE 100
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2865
Practice Address - Country:US
Practice Address - Phone:757-259-1900
Practice Address - Fax:757-259-1901
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101225817207R00000X, 2083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAH64569Medicare UPIN