Provider Demographics
NPI:1861423378
Name:LEVIN, MARC STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:STEPHEN
Last Name:LEVIN
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 1:10 MORWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7621
Mailing Address - Country:US
Mailing Address - Phone:314-289-6434
Mailing Address - Fax:314-289-7694
Practice Address - Street 1:915 N GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63106-1621
Practice Address - Country:US
Practice Address - Phone:314-289-6434
Practice Address - Fax:314-289-7694
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9E21207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A12271Medicare UPIN
086010183Medicare PIN