Provider Demographics
NPI:1053516047
Name:MARC L LEVINE M D F A C C P A
Entity type:Organization
Organization Name:MARC L LEVINE M D F A C C P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-732-6767
Mailing Address - Street 1:7135 BRUNSWICK CIR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-2539
Mailing Address - Country:US
Mailing Address - Phone:561-732-6767
Mailing Address - Fax:561-732-6701
Practice Address - Street 1:8200 JOG RD
Practice Address - Street 2:205
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33472-2981
Practice Address - Country:US
Practice Address - Phone:561-732-6767
Practice Address - Fax:561-732-6701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78197174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty