Basic Information
| Provider Information | |||||||||
| NPI: | 1487696431 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEVIN | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D, D.M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1305 POST RD | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | FAIRFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068246016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032594700 | ||||||||
| FaxNumber: | 2032590328 | ||||||||
| Practice Location | |||||||||
| Address1: | 1305 POST RD | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | FAIRFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068246016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032594700 | ||||||||
| FaxNumber: | 2032590328 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 09/08/2015 | ||||||||
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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 | 207Y00000X | 032601 | CT | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 010032601CT01 | 01 | CT | BLUE CROSS BLUE SHIELD | OTHER | 0147826015 | 01 | CT | CIGNA | OTHER | P2711818 | 01 | CT | OXFORD | OTHER | 2V2098 | 01 | CT | PHS | OTHER | 001326017 | 05 | CT | MEDICAID | 532601 | 01 | CT | CONNECTICARE | OTHER | 550789127 | 01 | CT | TAX ID | OTHER | 2970623 | 01 | CT | AETNA | OTHER |