Basic Information
| Provider Information | |||||||||
| NPI: | 1356335905 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEVENSON | ||||||||
| FirstName: | BARRY | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2979 SQUALICUM PKWY | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982251811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607341420 | ||||||||
| FaxNumber: | 3607566666 | ||||||||
| Practice Location | |||||||||
| Address1: | 2979 SQUALICUM PKWY | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982251811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607341420 | ||||||||
| FaxNumber: | 3607566666 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2005 | ||||||||
| LastUpdateDate: | 02/24/2009 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 03/25/2006 | ||||||||
| NPIReactivationDate: | 04/12/2006 | ||||||||
| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | MD00016093 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 8118440 | 05 | WA | MEDICAID |