Basic Information
| Provider Information | |||||||||
| NPI: | 1376714865 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARK DAVID LEVINE, A PROFESSIONAL CORP | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | COMMUNITY PSYCHIATRY ASSOCIATES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4626 2ND ST | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | DAVIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956189400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104861182 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1043 STUART ST | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | LAFAYETTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945494017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9252999033 | ||||||||
| FaxNumber: | 9252999030 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2008 | ||||||||
| LastUpdateDate: | 03/12/2008 | ||||||||
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| AuthorizedOfficialLastName: | LEVINE | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | DAVID | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5104861182 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
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.