Provider Demographics
NPI:1053571240
Name:LEVINE, PHILLIP R (MD)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:R
Last Name:LEVINE
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 1:39 WINDING WAY
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:PA
Mailing Address - Zip Code:15147-3886
Mailing Address - Country:US
Mailing Address - Phone:412-826-4822
Mailing Address - Fax:412-963-9702
Practice Address - Street 1:39 WINDING WAY
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:PA
Practice Address - Zip Code:15147-3886
Practice Address - Country:US
Practice Address - Phone:412-826-4822
Practice Address - Fax:412-963-9702
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026245L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine