Provider Demographics
NPI:1972566982
Name:LEVINE, RICHARD S (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:S
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:951 NW 13TH ST
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2359
Mailing Address - Country:US
Mailing Address - Phone:561-447-9341
Mailing Address - Fax:561-447-9352
Practice Address - Street 1:800 MEADOWS RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2304
Practice Address - Country:US
Practice Address - Phone:561-447-9341
Practice Address - Fax:561-447-9352
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL955302085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL05164OtherBCBSFL
FL278396700Medicaid
FLP00448988OtherRAILROAD MEDICARE
FLAF621ZMedicare PIN
A13276Medicare UPIN