Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DS025560L | PA |
Y | 204E00000X | Oral & Maxillofacial Surgeon | MD421768 | PA |
NPI | 1104855634 |
---|---|
Provider Name | Lawrence M Levin |
First Address | Philadelphia, PA 19104-4206 |
Second Address | Philadelphia, PA 19104-4206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 03/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0012815230001 | (05) | PA |
U32156 | (02) |