Basic Information
| Provider Information | |||||||||
| NPI: | 1376524728 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LEVINDALE HEBREW GERIATRIC CENTER AND HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7006 DELAWARE ST | ||||||||
| Address2: | |||||||||
| City: | CHEVY CHASE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208154162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016560282 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2434 W BELVEDERE AVE | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212155202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106012246 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LEVY | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECROR | ||||||||
| AuthorizedOfficialTelephone: | 4106012246 | ||||||||
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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 | 207RG0300X | D0060170 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | H330H192 | 05 | MD | MEDICAID |