Provider Demographics
NPI:1053578088
Name:LEVINE, JEFFREY GREGG (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:GREGG
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 1:10 CHERRY CT
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19444-2517
Mailing Address - Country:US
Mailing Address - Phone:610-564-3011
Mailing Address - Fax:812-461-0966
Practice Address - Street 1:10 CHERRY CT
Practice Address - Street 2:
Practice Address - City:LAFAYETTE HILL
Practice Address - State:PA
Practice Address - Zip Code:19444-2517
Practice Address - Country:US
Practice Address - Phone:610-564-3011
Practice Address - Fax:812-461-0966
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME138384207RG0100X
PAMD064045L207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E47796Medicare UPIN