Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DS17799L | PA |
NPI | 1053747717 |
---|---|
Provider Name | Dr. Fred Jack Levin |
First Address | Lancaster, PA 17601-3983 |
Second Address | Lancaster, PA 17601-3983 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2013 |
Last Update Date | 25/09/2013 |