Basic Information
| Provider Information | |||||||||
| NPI: | 1063404192 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEVITON | ||||||||
| FirstName: | MICHAEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 61 E 77TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100751817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127723111 | ||||||||
| FaxNumber: | 2128611796 | ||||||||
| Practice Location | |||||||||
| Address1: | 1701 AUGUSTINE CUT OFF | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198034415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026523016 | ||||||||
| FaxNumber: | 3025716270 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2005 | ||||||||
| LastUpdateDate: | 07/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | C-10003564 | DE | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 0000863001 | 05 | DE | MEDICAID |