Basic Information
| Provider Information | |||||||||
| NPI: | 1073618187 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEVY | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | ALAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 ELKRIDGE LANDING RD FL 2 | ||||||||
| Address2: | |||||||||
| City: | LINTHICUM | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210902924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434625010 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5 N LA PLATA CT STE 202 | ||||||||
| Address2: | |||||||||
| City: | LA PLATA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206465208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016094866 | ||||||||
| FaxNumber: | 2404483117 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2006 | ||||||||
| LastUpdateDate: | 06/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | D0089162 | MD | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 2713004 | 05 | OH | MEDICAID | 750849 | 01 | OH | BUCKEYE | OTHER | 000000215239 | 01 | OH | UNISON | OTHER | 415000 | 01 | OH | WELLCARE | OTHER | 5999527 | 01 | OH | AETNA | OTHER | 000000513620 | 01 | OH | ANTHEM | OTHER | 87-1469742 | 05 | MD | MEDICAID | P00412484 | 01 | OH | RAILROAD MEDICARE | OTHER |