Basic Information
| Provider Information | |||||||||
| NPI: | 1134364789 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARK DAVID LEVINE, MD WALNUT CREEK PROFESSIONAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 LA CASA VIA | ||||||||
| Address2: | SUITE 2-208 | ||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945983045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9252999033 | ||||||||
| FaxNumber: | 9252999030 | ||||||||
| Practice Location | |||||||||
| Address1: | 130 LA CASA VIA | ||||||||
| Address2: | SUITE 2-208 | ||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945983045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9252999033 | ||||||||
| FaxNumber: | 9252999030 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2008 | ||||||||
| LastUpdateDate: | 12/11/2008 | ||||||||
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| AuthorizedOfficialLastName: | LEVINE | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | DAVID | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9252999033 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.