Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0300X | Periodontist | DS0203264R | PA |
Y | 1223P0300X | Periodontist | MD3523 | MD |
NPI | 1073619755 |
---|---|
Provider Name | Martin Albert Levin |
First Address | Baltimore, MD 21218-2305 |
Second Address | Baltimore, MD 21210-1698 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 08/07/2007 |