Basic Information
| Provider Information | |||||||||
| NPI: | 1154324010 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEVY | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | NEAL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.P.M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1201 SEVEN LOCKS RD | ||||||||
| Address2: | STE 202 | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208542956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017624636 | ||||||||
| FaxNumber: | 3017626228 | ||||||||
| Practice Location | |||||||||
| Address1: | 1201 SEVEN LOCKS RD | ||||||||
| Address2: | STE 202 | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208542956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017624636 | ||||||||
| FaxNumber: | 3017626228 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2005 | ||||||||
| LastUpdateDate: | 01/11/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0131X | 00534 | MD | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery |
ID Information
| ID | Type | State | Issuer | Description | 79394-8500 | 05 | MD | MEDICAID |