Provider Demographics
NPI:1972738078
Name:LEVIN, MORAN (MD)
Entity type:Individual
Prefix:
First Name:MORAN
Middle Name:
Last Name:LEVIN
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 1:419 W REDWOOD ST
Mailing Address - Street 2:SUITE 420
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1734
Mailing Address - Country:US
Mailing Address - Phone:410-328-6533
Mailing Address - Fax:
Practice Address - Street 1:419 W REDWOOD ST
Practice Address - Street 2:SUITE 420
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1734
Practice Address - Country:US
Practice Address - Phone:410-328-6533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0077091207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology