Provider Demographics
NPI:1841525532
Name:STANLEY D LEVINE, MD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:STANLEY D LEVINE, MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-939-0336
Mailing Address - Street 1:20760 HYDE RD
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-9588
Mailing Address - Country:US
Mailing Address - Phone:707-939-0336
Mailing Address - Fax:707-938-8505
Practice Address - Street 1:20760 HYDE RD
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-9588
Practice Address - Country:US
Practice Address - Phone:707-939-0336
Practice Address - Fax:707-938-8505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC217632282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C217632Medicaid