Basic Information
| Provider Information | |||||||||
| NPI: | 1285000117 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEVKINA | ||||||||
| FirstName: | OLGA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2928 MAIN ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | GLASTONBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060331007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606578289 | ||||||||
| FaxNumber: | 8606578291 | ||||||||
| Practice Location | |||||||||
| Address1: | 2928 MAIN ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | GLASTONBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6065782898 | ||||||||
| FaxNumber: | 8606578291 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2015 | ||||||||
| LastUpdateDate: | 01/09/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 003920 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.