Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DS-022257-L | PA |
NPI | 1144306275 |
---|---|
Provider Name | Dr. Robert A Levine |
First Address | Philadelphia, PA 19115-2185 |
Second Address | Philadelphia, PA 19115-2185 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 18/02/2010 |