Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0004X | Dentist Anesthesiologist | 11703 | MD |
Y | 1223G0001X | General Practice | 11703 | MD |
Y | 213EG0000X | General Practice | 11703 | MD |
N | 1223G0001X | General Practice | DS028893L | PA |
N | 213EG0000X | General Practice | DS028893L | PA |
NPI | 1407973274 |
---|---|
Provider Name | Dr. Marvin Leventer |
First Address | Baltimore, MD 21201-1510 |
Second Address | Baltimore, MD 21201-1510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2007 |
Last Update Date | 26/10/2021 |